131 hansenÍase: resumos/hansenÍasis abstracts ... hanseníase: resumos/hanseníasis abstract -...

131HANSENÍASE: RESUMOS/HANSENÍASIS ABSTRACTS *

(Janeiro de 1988 a Dezembro de 1989)

CLINICA/CLINICAL ASPECTS

EPIDEMIOLOGIA E CONTROLE/EPIDEMIOLOGY AND CONTROL

GENERALIDADES/GENERAL ASPECTS

HISTOPATOLOGIA/HISTOPATHOLOGY

IMUNOLOGIA/IMMUNOLOGY

MICROBIOLOGIA/MICROBIOLOGY

PREVENÇÃO DE INCAPACIDADES FISICAS/PHYSICAL DISABILITIES PREVENTION

REABILITAÇÃO FISICA/PHYSICAL REHABILITATION

TERAPÊUTICA/THERAPEUTICS

(*) Os resumos estão organizados por assunto e dentro de cada assunto estão na ordem alfabética dos sobrenomes dos

autores. Também foram incluídos os editoriais (em alguns casos apenas a indicação). As revistas utilizadas foram:Indian Journal of Leprosy, International Journal of Leprosy e, Leprosy Review (Janeiro de 1988 a Dezembrode 1989).

Hansen. Int. 14(2)131-199, 1989.

Hanseníase: Resumos/Hanseníasis Abstract - CLÍNICA 133

AGUSNI, I. et al. Blood Flow Velocity In Cutaneous

Lesions of Leprosy. Int. J. Leprosy, 56(3):394-

400, 1988.

SUMMARY - The velocity of blood flow in the

cutaneous lesions of leprosy was measured by the

noninvasive technique of laser-Doppler velocimetry in

nine male patients, all under treatment with World

Health Organization multidrug regimens. In three

patients with stable borderline tuberculoid (BT)

lesions, the blood-flow velocity was slightly faster

over the lesion than that in adjacent uninvolved skin.

There was no substantial difference between different

sites at the center and edge of individual lesions in

each patient, but there was some variation between

subjects. In one other BT patient with a reversal

reaction, blood-flow velocity was 20-fold greater than

in adjacent uninvolved skin. In four patients with

stable borderline lepromatous/lepromatous (BL/LL)

disease, the blood-flow velocity was 3 to 9 times

faster over the plaques than in adjacent skin. There

was relatively little difference between measurements

over comparable points at the edge and center of

individual plaques, or between plaques in the same

patient, but there were considerable differences

between patients. A firth BL patient reversal reaction

showed generally similar results to those found in the

stable BL/LL patients.

Histometric study of the biopsies taken

immediately after blood-flow measurement from two

different plaques on each of four BL patients showed a

clear relationship between the granuloma fraction

measured by planimetry and the blood-flow velocity.

This finding suggests that laser-Doppler velocimetry

might prove to be a useful, clinically acceptable,

noninvasive technique for monitoring the severity of

hyperemia as an early indication of reversal reaction

during chemotherapy trials in leprosy patients.

AL-MOHAYA, S.A. et al. Renal Granuloma and

Mesangial Proliferative Glomerulonephritls In

Leprosy. Int J. Leprosy, 56(4):598-602, 1988.

Hansen. Int 14(2):133-150, 1989.

SUMMARY - A 17-year-old, Yemeni male

patient with borderline lepromatous leprosy and

erythema nodosum leprosum (ENL) developed a

nephritic range proteinuria. A renal biopsy revealed

mesangial proliferative glomerulonephritis and

epithelioid granulomas in the interstitium. The

presence of granular immunofluorescence for C3 and

electrondense deposits in the glomerull indicated an

immune complex glomerulonephritls. Clinical signs of

ENL subsided rapidly under steroid treatment. The

unusual combination of proliferative

glomerulonephritis and epithelioid granulomas in

leprosy is presented and discussed.

ANILKUMAR, G. et al. Malignant transformation of

trophic ulcer in leprosy. Indian. J. Leprosy,

60(3)385-388, 1988.

ABSTRACT - Malignancy developing in the

trophic ulcer of leprosy is no more a rarity. In four

years period we detected seven cases of squamous

cell carcinoma developig in the trophic ulcer in

patients with lepromatous leprosy.

ANILKUMAR, G. et al. Tetanus in patient with

lepromatous leprosy (I). Indian J. Leprosy,

60(3):448-449, 1988.

ABSTRACT - Tetanus in lepromatous leprosy is

rare and reported occasionally as case reports only.

We present a case of lepromatous leprosy who

succumbed to death due to rapidly progressing

tetanus. The mechanisms of protection from tetanus

in leprosy is discussed.

ANILKUMAR, G. et al. Tetanus in leprosy patient (II).

Indian J. Leprosy, 60(3):450-452, 1988.

ABSTRACT - Leprosy patients are protected

from tetanus due to acquired natural immunity


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gainst tetanus. The inddence of tetanus in Leprosy Is

ery low. A case of Indeterminate Leprosy developing

etanus following injury and terminating fatally is

resented.

RORA, S. K. et al. Calcification of uinar nerve in

leprosy - a case report. Indian J. Leprosy,

61(1):111-112. 1989.

BSTRACT - A case of Tuberculoid leprosy who had

aken irregular treatment for five years and had

hickened ulnar nerve which on radiological

xamination showed calcification, is reported.

RORA, S.K. et al. Study of cutaneous lesions of

leprosy on male genitalia. Indian J. Leprosy,

61(2):222-224, 1989.

ABSTRACT - The cutaneous lesions of leprosy on

ale genitalia were studied. They were found in 2.9%

f cases examined in this series. They were seen

ost commonly in borderline group. It is emphasised

hat it is not uncommon to find lesions on male

enitalia in leprosy.

RORA, S.K et al. A study of palmo-plantar lesions in

leprosy:a preliminary report Indian J. Leprosy

61(2):206-208, 1989.

ABSTRACT - Out of 500 leprosy patients

creened for palmar and/or plantar lesions, eighteen

ases were detected. They were classified according

o RidleyJopling classification. In majority of cases it

as macular lesion. Cases were from TT, BT and BB

roup. In 50% cases, palmo-plantar involvement was

ssociated with type I reaction. In 66.7% case, it was

xtension of patch from surrounding area, 11,1%

ases isolated lesions were seen and In 22.2% cases

oth extension as well as isolated lesions were

resent

ansen. Int. 14(2):133.160. 1889.

BHARADWAJ, V. P. & KATOCH, K. Detection of

subclinical Infection in leprosy: and 8 years

follow-up study. Indian J Leprosy, 61(4):495-

502, 1989.

ABSTRACT - A follow-up study has been carried

out using Fluorescent Leprosy Antibody Absorption

(FLA-ABS) test in-1069 healthy contacts of multi and

paucibacillary leprosy patients. Simultaneously

lepromin testing with Dharmendra antigen has also

been done to determine their delayed type

hypersensitivity. In nearly 8 years of follow-up, 46

contacts have developed disease and of these 41

contacts were FLA-ABS positive and lepromin

negative. It is inferred that test (alongwith) can be

used to identify the contacts who are at higther risk of

developing the disease. FLA-ABS test has also been

found to be highly sensitive for detection of subclinical

infection specially in younger age groups. This test

could therefore serve as a very sensitive

epidemiological tool for assessing the extent of

disease in the community and for monitoring the

transmission of disease especially after MDT and other

Intervention measures.

BHATIA, V.N. Effect of temperature, cholesterol and

nerve tissue on multiplication of armadillo M.

leprae. Indian J. Leprosy, 61(4)453-457,

1989.

ABSTRACT - The effect of temperature, nerve

tissue and certain constituents of the medium on

multiplication of armadillo M. Leprae was studied

using Hanks BSS. An equal or better growth was seen

at 30°C and 10°C compared to 37°C. Multiplication

was also seen at - 20°C. Adding cholesterol, foetal calf

serum, cystine-HCI, sodium thioglycollate or nerver

suspension and covering medium with liquid paraffin

each showed beneficial

Hanseníase: Resumos/Hanseniasis Abstract - CLÍNICA 135

effect. Hanks containing foetal calf serum, cholesterol

with sodium thioglycollate or cystine-hydrocloride

showed maximum multiplication. These combinations

may be used for testing additional factors for further

Improvement of the medium.

CHATTOPADHYAY, S. P. & GUPTA, C.M. Primary

hyperpigmented cutaneous lesions in

tuberculoid leprosy. Indian J. Leprosy,

60(1):63-65, 1988.

ABSTRACT- Two cases of tuberculoid leprosy

with primary hyperpigmented anaesthetic lesions are

reported and subject is reviewed.

CHATTOPADHYAY, S.P. et al. Bilateral involvement of

sole and palm in leprosy - a case report. Indian

J. Leprosy, 61(2):266-267, 1989.

ABSTRACT - A case of BT leprosy in reaction

with lesions over uncommon (immune) sites like palm

and sole has been reported.

CHATTOPADHYAY, S.P. et al. Multiple synovial

swellings in BT leprosy - a case report. Indian

J. Leprosy, 61(2):263-265, 1989.

ABSTRACT - A case of Leprosy with multiple

synovial swellings has been reported. Rarely theses

swellings may be an initial presentation and at sites

other than dorsum of hand or ankle as was in this

case. The literature on the subject is briefly reviewed.

CHAUDHARY, S.D. et al. Leukemoid reaction in

erythema nodosum leprosum In a leprosy

patient. Indian J. Leprosy, 60(4):572-576,

1988.

ABSTRACT - A case of lepromatous leprosy

Hansen. Int 14(2):133-150, 1989.

with erythema nodosum leprosum (ENU presenting as

a myeloid leukemold reaction is reported. Very high

leucocyte count with immaturity of the cells in myeloid

series was present in peripheral blood. High leucocite

alka"-ie phosphatase score, absence of

hepatosplenomegaly and transient nature of

leukemoid reaction differentiated it from chronic

myeloid leukemia and acute myetoblastic leukemia.

The possible mechanisms of leukemoid reaction in

ENL are discussed.

COUTRIGHT, P.D. Defining the Magnitude of Ocular

Complications from leprosy: Problems of

Methodology. Int. J. Leprosy, 56(4):566-

573. 1988.

SUMMARY - A comprehensive review of all ocular

surveys (4)) of leprosy patients was undertaken.

These surveys do not provide adequate information

for defining the incidence or prevalence of ocular

disease caused by Mycobacterium leprae.

Furthermore, the level of disability and blindness from

leprosy has not been addressed. The primary

methodologic problems in these surveys are: a) lack

of survey sampling techniques, b) institution-based or

clinic-based populations as the study population, c)

inadequate instruments for the detection of clinical

signs, d) non-ophthalmically trained individuals as

examiners, e) definition of 'ocular° disease that

includes non-ocular condition, f) failure to analyze by

disease type, and g) failure to analyze by duration of

disease or therapy. All of these studies were cross-

sectional in nature. While this type of study Is

beneficial to health administrators for prioritizing eye

care in health planning, a longitudinal study is

required to investigate the risk factors for ocular

involvement and blindness in these patients,

COWLEY, S.A. et al. Nerve Damage Induced by

Mycobacterial Granulomas in Guinea Pig Sciatic

Nerves. Int. J. Leprosy, 56(2):283-289, 1988.

SUMMARY - A possible model for nerve damage

in leprosy has been developed in the sciatic nerve of

the guinea pig. Intraneural injection of 10 BCG

organisms into an unsensitized animal induces an

epihelioid cell granuloma in 2 weeks similar to that

found In tuberculoid leprosy patients. In contrast

intraneural injection of 109 cobalt-irradiated

Mycobacterium leprae organisms Induces a

macrophage granuloma in 5 weeks, similar to that

found in lepromatous leprosy patients. Histological,

immunohistochemical, eletron microscopical and

electrophysiological studies have demonstrated that

the lesions induced in the experimental animals show

many of the features documented in studies of nerve

damage in leprosy patients.

DHAND, V.K. et al. Phrenic Nerve Conduction in


SUMMARY - Phrenic nerve conduction was

performed bilaterally in 22 multibacillary (BL-LL) and

18 paucibacillary (BT-TT) leprosy patients and 25

control subjects. Prolonged phrenic nerve conduction

time and/or reduced amplitude of diaphragm muscle

action potential beyond 2.5 standard deviations of

control mean values was observed in 9 BL-LL patients

(4 bilateral) and 6 BT-TT patients (all unilateral). Out

of the nine BL-LL patients with phrenic nerve

involvement, median motor and/or sensory nerve

conduction was also abnormal In seven patients. On

fluoroscopy, diaphragnm movements were normal in

all patients. The study documents subclinical phrenic

nerve involvement in leprosy - a fact not previously

recognized.

DORAIRAJ, A.; REDDY, R. & JESUDASAN, K. An

evaluation of the Semmes-Weinstein 6.10

monofilament as compared with 8 nylon in

leprosy patients. Indian J. Leprosy, 60(3):413-

417, 1988.

Hansen. Int 14(2): 133-150, 1989.

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136
ABSTRACT - In as previous study Birke and Sims

1986)1 identified the 5.07 (10 y) SemmesWeintein

onofilament, as the most useful tool, in measuring

rotective sensation in the sole of the foot of leprosy

atients. This study has demonstrated that the

tandard 6 Nylon being used in Karigiri, is as good as

he monofilament, in assessing protective sensation in

eprosy patients. However there is a need for

tandardising procedures for measuring sensory loss

n leprosy patients

'SOUZA, Dods & THOMAS, I.M. Chromosome

aberrations and sister chromatid exchanges

(SCEs) in peripheral blood lymphocyte cultures of

untreated leprosy patients. Leprosy Rev.,

59:121-125, 1988.

SUMMARY - The frequencies of various

hromosome aberrations and sister chromatides

xchanges (SCEs) were studied in blood lymphocyte

ultures of untreated leprosy patients. The frequency

f chromosome aberrations was significantly higher in

epromatous (P < 0,001) and tuberculoid (P < 0.02)

roups in comparison with that of controls. The

requency of SCEs was found to be within normal

ange in the tuberculoid group whereas In

epromatous group, a significant (P < 0.001) Increase

as observed. The findings indicate a probable

orrelation between the form of leprosy and

hromosome damage.

GARG, R. et al. Adreno-cortical functions In leprosy.

Indian J. leprosy, 80(4):809-815, 1988.

ABSTRACT - Adreno cortical function was carried

ut In 43 cases of leprosy. These cases were further

ivided Into tuberculoid, borderline, lepromatous and

epra reaction. Serum and urinary electolyte urinary,

7-Ketosterold and 17-Ketogenic


steroid and plasma cortisol levels were measured to

assess the adrenocortical status In these different

forms of leprosy.

It was observed that these parameters were

within normal limit In tuberculoid leprosy except low

value of urinary-Ketogenic steroid. The borderline

and Lepromatous leprosy cases revealed low values

of urinary sodium, potassium and 17-Ketogenic

steroid and high level of serum potassium. However

the cases of lepra reaction revealed low value of

serum and urinary sodium and potassium, urinary

17-Ketogenic steroid. The basal plasma cortisol level

was in this group but it was statistically insignificant.

GARG, R. et al. Hormone profile in leprosy. Indian J.

Leprosy, 61(4):428-431, 1989.

ABSTRACT - Hormone profile were carried out in

35 male cases of leprosy. They were divided into

tuberculoid leprosy, borderline leprosy, lepromatous

leprosy and lepra reaction. Serum testosterone,

follicle-stimmulating hormone, Leutinizing hormone,

and Oestradiol level were measured in these cases of

leprosy. It was observed that serum testosterone

were significantly low in lepromatous leprosy (P <

0.001) and lepra reaction (P < 0.01). The serum

levels of follicle-stimulating hormone and leutinizing

hormone were significantly high in lepromatous

leprosy (P < 0.02) and lepra reaction (P < 0.05).

Serum Oestradiol was raised in approx. 60% cases in

borderline leprosy, lepromatous leprosy and lepra

reaction.

GHEI, S. K. et al. Dermatoglyphics in leprosy: (Ill)

creases of palm. Indian J. Leprosy, 61(1):96-

102, 1989.

ABSTRACT - Palmar configurations of triradii

and creases of 100 leprosy patients [50 lepromatous

(BULL) and 50 tuberculoid (BT/LL)] were compared

Hansen. Int 14(2):133-150, 1989.

with those of 100 normal persons selected from

families of these patients.

The patterns of position of triradii were similar

in controls and leprosy patients as such. But, the

patterns in the two types of leprosy patients were

different. As for palmar creases patterns, there was

significant difference between those of controls and

patients, double radial base crease occurring more

often in patients. However, the differences between

the two types of patients were not statistically

significant

GHORPADE, A. et al. Tuberculoid leprosy on hairy

scalp: a case report. Leprosy Rev., 59:235-

237, 1988.

SUMMARY - Involvement of the hairy occipital

area of scalp in a patient having tuberculoid leprosy

is reported. To the best of our knowledge,

involvement of hairy scalp by a tuberculoid lesion has

not been reported so far.

GIBBELS, E. et al. Unmyelinated nerve fibres in

leprosy. A qualitative and quantitative study of

sural nerve biopsies in 2 cases of lepromatous

leprosy. Leprosy Rev., 59:153-162, 1988.

SUMMARY - Since morphometric analysis of

unmyelinated nerve fibres is lacking in leprosy

literature, they were investigated in sural nerves of 2

lepromatous cases. Despite normal or even increased

total numbers of unmyelinated axons, tentative

differentiation in not-yet-myelinated axons and

genuine unmyelinated fibres or their regenerates

according to associated Schwann cells and fibre

calibres revealed a mild to severe loss of genuine

unmyelinated fibres. A predominant involvement,

surpassing loss of genuine myelinated fibres, could

not be stated in either case. Quantification of

degenerating unmyelinated fibres, denervated

Schwann ceil complexes, and Schwann cell nuclei -

both of the unmyelinated type - Is also presented and

discussed.

GIRDHAR, A. at al. Leprosy in Infants - Report of Two

Cases. Int J. Leprosy, 57(2):472-475, 1989.

SUMMARY - Two infants, one 4 months old and

the other 2 months old, having histologically

confirmed indeterminate leprosy are reported. The

route of infection, mode of transmission, and

incubation period are discussed with reference to

these two cases of infantile leprosy.

GUPTE, M.D et al. Reliability of direct skin smear

microscopy in leprosy. Indian J. Leprosy,

60(4):566-571, 1988.

ABSTRACT - Skin smear direct microscopy is an

important tool for diagnosis of leprosy. The study was

planned to understand the reproducibility of skin

smear reading by a trained technician. Skin smears

were collected from known patients of leprosy from

the field area. They were stained for acid fast bacilli

following the standard cold staining procedure and

were read following the Riddley scale. A sample of

smears was re-examined on two occasions by the

same technician, following blind procedure. There was

a systematic under reading on the second occasion,

which was attributed to the defective storage of the

slides . However the agreement between second and

third examinations was very good (Concordance

81.34%, Kappa 0.74). The finding was confirmed on a

repeat examination. It can be concluded that the

Direct Skin Smear Microscopy is a reliable and

reproducible technique under experimental conditions.

HALDAR, S. R. et al Tuberculoid granuloma in a

clinically normal looking skin. Indian J.

Hansen. Int. 14(2):133-160, 1989.

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Leprosy, 80(2):277-279, 1988.

ABSTRACT - A case of tuberculoid leprosy

howing well defined tuberculoid granuloma in the

kin without any morphological changes is reported.

ODES, R.M. & TEFEREDEGNE, B. Tetanus In Leprosy

Patients: Report of Five Cases. lnt J. Leprosy,

56(2):228-229, 1988.

SUMMARY - It has long been noted that tetanus

s rare in leprosy patients. Five cases of tetanus are

eported In leprosy patients in Addis Ababa, Ethiopia.

lthough natural immunity to tetanus occurs and this

ppears to be higher in leprosy patients than in the

eneral population, it is not completely protective.

urther research on the relationship between tetanus

nd leprosy is indicated. Although firm epidemiologic

ata are lacking, it is prudent to give leprosy patients

t least one dose of tetanus toxoid.

ACOB, M. & MATHAI, R. Diagnostic Efficacy of

Cutaneous Nerve Biopsy in Primary Neuritic


SUMMARY - The role of nerve biopsy In the

iagnosis of primary neuritic leprosy was evaluated in

study of 77 patients who had symptoms of

eripheral neuropathy without hypopigmented

atches, positive skin smeas, or a skin biopsy

onsistent with leprosy. A biopsy of a representative

utaneous nerve near the site of the neurological

eficit was taken for histopathological examination

nd acid-afst staining. Nearly half of the patients had

eprosy confirmed by nerve biopsy, and the entire

pectrum of leprosy was represented. No significant

elationship was seen by age or sex or type of

europathy. The duration os symptoms did not

orrelate with the severity of nerve damage as seen

istologically. The probability of false-positive or false-

egative results is discussed In light of clinical

Hanseníase: Resumos/Hanseniasis Abstract - CLINICA 139

management. Being a relatively simple o„toe

procedure, a cutaneous nerve biopsy is strongly

recommended as an important diagnostic tool.

particularly for primary neuritic leprosy.

JOB, C.K.; JACOBSON, R.R. & HASTINGS, R.C.

Simultaneous Upgrading Reaction and Erythema

Nodosum Leprosum in a Patient with

Lepromatous Leprosy. Int. J. Leprosy,

56(3):437-442, 1988.

SUMMARY - A case of lepromatous leprosy with

erythema nodosum leprosum (ENL) undergoing

treatment with dapsone, rifampin, and thalidomide

developed focal tuberculoid granulomas in the ENL

lesions. This is the first report known to the authors of

a lepromatous leprosy patient in whom ENL and an

upgrading reaction occurred simultaneously.

JOB, C.K. et al. Single Lesion Subpolar

Lepromatous Leprosy and its Possible Mode of

Origin. Int. J. Leprosy, 57(1):12-19, 1989.

SUMMARY - Three case reports of patients with

a single, nodular, subpolar lepromatous skin lesion,

one on the left elbow, another on the posterior aspect

of the left leg, and the third on the extensor ulnar

aspect of the right forearm, are presented. The

lesions, clinically and histopathologically, resemble

lepromas which develop at the site of experimental

Inoculation of Mycobacterium leprae in armadilos.

These are sites on the body which are likely to be

traumatized. With the distinct possibility of the

presence of viable M. leprae in the soil of Louisiana

and Texas from wild armadillos with the natural

disease, it is suggested that these three patients

acquired the infection from the environment and had

inoculation lepromas.

KOHU, M. et al. Urinary Excretion of Renal Brush-

Hansen. Int. 14(2):133-180, 1989.

border Enzymes in Lepromatous Leprosy - a

Preliminary Investigation. Int. J. Leprosy,

57(1):20-23, 1989.

SUMMARY - Activities of the brush-border

enzymes, alkaline phosphatase, maltase, leucine

aminopeptidase, and gamma-glutamyl transpeptidase,

were measured in urine samples of 25 lepromatous

leprosy patients and en equal number of age-matched

healthy controls. None of the patients were shown to

be suffering from any other systematic disease. The

enzymatic activities were shown to be significantly

elevated in leprosy patients when compared to

controls.

KORANNE, R.V. & SRIVASTAVA, G. Primary drug

resistance to both rifampicin and dapsone in a

paucibacillary leprosy patient. Indian J.

Leprosy, 60(1):90-92, 1988.

ABSTRACT - A thirty-one year old male patient

was diagnosed and treated for a pure or better

primary neuritic case of leprosy with dapsone (100 mg

daily for 2 years) and rifampicin (600 mg daily for 6

months). From the very onset, the patient did not

show any improvement; on the tope of it he

subsequently, developed a cutaneous patch, which on

histopathological examination, revealed classical

features of BT leprosy. Acid-fast bacilli were absent

both in skin slit smear and histologic section. A

primary resistance to both dapsone an rifampicin,

even in paucibacillary patient, is speculated.

KUMAR, B. et al. Involvement of palate and cheek in

leprosy. Indian J. Leprosy, 60(2):280-284,

1988.

ABSTRACT - Cases of bacillary positive leprosy

with no apparent lesion in the oral cavity, soft or hard

palate were studied for any evidence of pathological

involvement. Granulomata were present

In 11 (65%) out of 17 cheek biopsies studied. M.

Ieprae were Identified in four specimens only, 9

specimens (64%) out of 14 palate biopsies showed

definite granulomata. M. leprae were seen in six

specimens.

KUMAR, N.; SARASWAT, P.K & SHANKER, A.

Estimation of high density lipoprotein cholesterol

In the diagnosis of lepromatous leprosy. Indian

J. Leprosy, 60(4): 600-603, 1988.

ABSTRACT - A high incidence of increase plasma

level of high density lipoprotein cholesterol (HDL-C)

has been reported In cases of lepromatous leprosy.

HDL-C levels were estimated in 96 (50 under

treatment and 46 untreated) lepromatous leprosy

patients and 84 ramdomly selected matched control

patients suffering from other skin diseases attending

skin out-patients department. HDL-C estimations were

performed for the diagnosis of lepromatous leprosy in

patients aged below 60 years, taking plasma HDL-C

levels as 28-71 mg/dl in men and 34-91 mg/dl in

women, as range of normal values. The study

revealed that HDL-C levels in lepromatous leprosy

group were raised and significantly different when

compared with control group (1 = 35.1668 and P <

0.001). The sensitivity of the test was very high, 97.9

per cent (94/96), but specificity was low 80.95 per

cent (68/84). False positive and false negative results

were 19.04 per cent (16/84) and 2.08 per cent (2196)

respectively. It is opined that a negative test will be

mainly useful in excluding diagnosis of lepromatous

leprosy.

KUMAR. R.; BAJAJ, M. M. & SWAROOP, B.

Conformation changes in the IgG molecule of

lepromatous sera using laser raman

spectroscopy. Indian J. Leprosy, 60(3): 363-

359 1988.

Hansen. Int. 14(2): 133-150, 1989.

140
ABSTRACT - In the present work we report our

studies on IgG separated from the serum of

lepromatous patients and non-lepromatous leprosy

cases using Laser Raman Spectroscopy. Striking

spectral changes in LL cases have been observed in

the following special regions:(a) the amide f and III,

(b) the SS and C-S stretching (c) the skeletal bending

and (d) skeletal stretching regions. These changes

indicate a decrease In the amount of B- structure and

a transition towards A-helical conformation.

KUMAR, V. et al. Ultrastructural studies of peripheral

nerves in lepromatous leprosy patients. Indian

J. Leprosy, 60(3):360362, 1988.

ABSTRACT - Ultrathin sections of the peripheral

nerves taken from three lepromatous leprosy patients

(One untreated, other treated and third in ENL,

reaction) was examined in the electronmicroscope. In

the untreated patient, solid M. Ieprae organism inside

the Schwann cell and the degeneration of Schwann

cell was seen. In contrast, the treated patient showed

the degeneration of bacilli and myelinated fibres.

However, the characteristics of cells in the ENL

reaction showed close similarities with the untreated

case.

LEVIS, W.R. et ai. Testicular dysfuntion in leprosy.

relationships of FSH, LH and testosterone to

disease classification, activity and duration.

Leprosy Rev., 60(2):94-101, 1989.

SUMMARY - Luteinizing hormone (LH), follicle-

stimulating hormone (FSH) and testosterone levels

were determine by radioimmunoassay (RIA) in leprosy

patients and analysed for effect of disease

classification, disease activity and duration of disease,

LH and FSH levels were found to be significantly

elevated in lepromatous patients compared to

borderline-lepromatous, mldborderline


and borderline-tuberculoid patients. A positive

correlation was seen between LH and FSH and a

negative correlation was seen between testosterone

and both LH and FSH. No correlation was seen

between hormone levels and measures of disease

activity: bacillary index and IgM to phenolic glycolipid

I, a Mycobacterium feprae antigen. A significant

correlation was seen between duration of disease and

FSH when age was taken into account, indicating that

testicular dysfunction is probably cumulative and

irreversible. It is recommended that LL patients be

routinely screened for hypogonadism using FSH, LH

and testosterone levels.

LORD, R. et al. Skin Test Studies on Close Contacts of

Leprosy Patients in Índia. Int J. Leprosy,

57(4):801-809, 1989.

SUMMARY - Skin-test studies with a series of

tuberculin has been carried out in close contacts of

multibacillary (MB) leprosy patients around three

leprosy centers in India, and in casual contacts of the

disease around two centers. The results show that the

rate of acquisition of leprosin A positivity is associated

with age and the closeness of contact with MB

leprosy. At the age of 15 years, the differences

between the two types of contact were highly

significant (p<0.00001). Many responses to leprosin A

are directed toward the group iv, species- specific,

antigens of the leprosy bacillus, and the significance

of positivity is discussed in relation to protective

immunity from leprosy. The differences from Iran

show that positivity to leprosin. A is not solely the

efect of the degree of contact with the disease, but

must also have a genetic or environmental element,

the latter being favored. i

The results from Miraj show that the high levels

of tuberculin, scrofulin, and vaccin positivity seen in

Fathimanagar, and to a lesser extent in Karigiri, are

not a consequence of contact with leprosy. BCG

vaccination made little difference to the leprosin A

positivity of close contacts of leprosy patients,

Hansen. Int., 14(2): 133-150, 1989.

although It significantly enhanced positivity among

casual contacts around Miraj (p<0.002). BCG

vaccination significantly Increased tuberculin positivity

in Miraj and kKarigiri, and In those under 11 years of

age in Fathimanagar. It made no difference to the

already high level of positivity found in older persons

around Fathimanagar. Gender was found to influence

skin-test responses In close contacts tested around

Fathimanagar who were BCG vaccinated, but made no

difference among the nonvaccinated.

When used with care, leprosin A Is a valuable

tool for the study of the effects of contact with

leprosy, and illustrates the high infectivity of the

organism, yet comparatively low Incidence of disease.

MARKS JR., S.C. & GROSSETETE, G. Fades Leprosy

Resorption of Maxilary Anterior Alveolar Bone

and the Anterior Nasal Spine in Patients with

Lepromatous Leprosy in Mali. Int. J. Leprosy,

58(1):21-25, 1988.

SUMMARY - Resorption of the anterior nasal

spine and alveolar bone in the anterior maxilla was

measuerd in 39 patients with lepromatous leprosy in

Mali. Bone resorption occurred in both of these sites,

but resorption in one did not predict resorption in the

other. These data are interpreted to mean that

resorptions of bone anterior (nasal spine) or inferior

(alveolar bone) to bacillary populations In the nasal

mucosa of patients with lepromatous disease In Mall

occur independently.

MISHARA, B. et al. A borderline leprosy lesion on the

palate: a case report. Leprosy Rev, 59:71-

74,1988.

SUMMARY - A patient with borderline

tuberculoid leprosy was found to have involvement of

hard palate which was histologically compatible with

borderline leprosy (BB) in reaction. The possible

modes of involvement of palate are discussed.

MOHAN, L et al. A report on six cases of histoid

variety of lepromatous leprosy in children.

Indian J. Leprosy, 61(1):103-108, 1989.

ABSTRACT - Six cases of histoid variety of

lepromatous leprosy among children below 12 years of

age were detected in over 3 years period.

Bacteriological index was high (3 to 5+). None of the

patients had received any anti-leprosy treatment. It is

a public health problem because of infectious nature

of the disease, therefore early detection and

management of this entity among children is

Important.

MOUDGIL, K. D. et al. Serological pattern of hepatitis

B virus markers (HBsAg, anti-HBs, IgM anti-HBc

and HBV specific DNA polimerase) in leprosy

patients. Indian J. Leprosy, 61(1): 54-60,

1989.

ABSTRACT - Sera of 134 lepromatous (LLLBL)

and 57 tuberculoid (TTIBT) leprosy patients were

analysed for four HBV markers. HBsAg was detected

in 6.71% of lepromatous and 3.5% of tuberculoid

sera. The per cent positivity of lepromatous and

tuberculoid sere for anti-HBs antibodies was 30.59%

and 35.08%, respectively. The positivity of normal

sera for HBsAg and anti-HBs was 3.60% and 21.69%

respectively. The difference in the positivity of three

groups of sera (lepromatous, tuberculoid and normal)

for HBsAg or anti-HBs was not statistically significant

Anti-HBc (IgM) antibodies were detected in 6% of

lepromatous sera. HBV-specific DNApolymerase

activity was found in 22.22% of HBsAg positive (but

anti-HBc negative) sera, and 66.66% of anti-HBc.

positive (but HBsAg negative) sera. The pattern of

acute HBV Infection in leprosy patients followed the

typical pattern prevalent In the normal population.

Hansen. Int 14(2): 131-150, 1989.

142
MUKHERJEE, A.; MISRA, R.S. & MEYERS, W. M. An

Electron Microscopic Study of Lymphatics in the

Dermal Lesions of Human Leprosy. Int. J.

Leprosy, 57(2):506-510, 1989.

SUMMARY - The dermal lymphatic vessels in

lepromatous and tuberculoid leprosy lesions were

studied by light and electron-microscopy. In the

lepromatous patient, lymphatic vessels were seen in

both infra- and pert-granulomatous areas. The

lymphatic lining cells contained lipid droplets,

lysosomes, and numerous pinocytotic vesicles. Cells

bearing bacilli were only occasionally seen. In the

tuberculoid cases, lymphatic vessels were seen only

along the edges of the granulomas and the lining cells

were less prominent. Inflammatory cells, both

lymphocytes and histlocytes, were found traversing

the walls of lymphatic vessels in both groups of

patients. The results of the study confirm the

continued and increased functioning of the lymphatic

drainage system in dermal leprosy lesions and

indicates that it may be a major route for the

clearance of lipides from the lipid-rich haciiliferous

lesions in the lepromatous patient. The limphatic

pathway appears to be a minor pathway for the

disseminations of Mycobacterium leprae in comparison

with the blood vascular system.

MWATHA, J. et al. A comparative evaluation of

serological assays for lepromatous leprosy.

Leprosy Rev., 59:195-199, 1988.

SUMMARY: A compartive antibody analysis of

sera from 26 patients with lepromatous leprosy

showed consistently high titles to the phenolic

giycolipid I disaccharide and to the ML04 epltope of

the 35 kD protein antigen of Mycobacterium leprae.

Antibody titres of these two specificities were

positively correlated (p<0.01) and both declined after

chemotherapy, although this trend was apparent

earlier after the onset of therapy for the anti-35kD

antibody response. Two healthy subjects (out of 18


tested) from the leprosy endemic area had

pronounced anti-PGL-1 but no demonstrable anti35kD

antigen activities. In constrast with the above results,

antibody levels to lipoarabinomannan were much

lower and with great individual variation between the

LL patients. Finely, antibody levels to the M. leprae-

specific 111E9 epitope (peptide 422-436) of the 65kD

proteins antigen were not demonstrable in the

majority of LL patients.

NAGESHA, C.N. et al. A concentration method for

detection and quantitation of bacillaemia in

leprosy and its comparison with other techniques.

Leprosy Rev., 59:337-340, 1988.

SUMMARY - Detection and quantitation of

bacillaemia in 50 untreated cases of leprosy were

evaluated by the buffy coat method, the haemolysis

method and the present Petroff s method. Bacillaemia

was detected in 29 (58%) out of 50 cases and in 32

LL-BL cases it was detected in 28 patients with a

success rate of 87.5%. Both the haemolysis method

and Petroff s method were found useful in estimating

the bacillary load per millilitre of blood. Importantly,

the smears of concentrated deposit obtained by

Petroffs method revealed ondly AFB free from any

artefacts and also yielded high bacterial counts. In

conclusion, Petroff's method of concentration was

found superior over other methods for detection and

quantitation of bacillaemia in the lepromatous

spectrum (LL-BL) of the disease.

NAIK, R.; BHARATHI, S. & BAI, B. M. Squamous cell

carcinoma developing In trophic ulcer in leprosy.

Indian J. Leprosy, 60(3): 380-384 1988.

ABSTRACT - Two cases of leprosy patients having

trophic uilcer over the heel, later developed squamous

cell carcinoma are reported along with follow up.

Hansen. Int. 14(2)133-150, 1989.

NAYAK, K.C. et al. A study of incidence of Austráliaantigen and derangement in liver function tests inleprosy. Indian J. Leprosy, 61(1): 23-30, 1989.

ABSTRACT - The present study was conducted

in 50 patients of various subtypes of leprosy

(Lepromatous, Tuberculoid, Borderline borderline) and

25 healthy control, for detection of Australia antigen

and various liver function testes (serum protein,

cholestrol, alkaline phosphates, SGOT, SGPT,Bilirubin

and liver biopsy)to see incidence of Australia Antigen

and derangement in liver fundion. It was concluded

that incidence of Australia antigen in study and control

group was zero. Total serum protein and serum

globulin was increased In lepromatous leprosy. A/G

ratio was reversed in 34.3% and 50% in lepromatous

and tuberculoid leprosy respectively. Granulomatous

hepatitis was seen in 68.66% and 50% cases of

lepromatous and tuberculoid leprosy respectively. No

relationships was established between hepatic lesion.

Australia antigen and liver function test.

NEYLAN, T.C.; NELSON, K.E.; SCHAUF, V. &

SCOLLARD, D.M. Illness Beliefs of Leprosy

Patients: Use of Medical Anthropology In Clinical

Practice. Int. J. Leprosy, 58(2):231237, 1988.

SUMMARY - Illness beliefs of 61 patients

identified as having leprosy were assessed by

Kleinman's Explanatory Model Format. Our patients

used a wide variety of etiologic theories which were

grouped in categories such as venereal disease,

heredity, dangerous food, sin, karma, and humoral

disorders. Despite effors at patient education, very few

patients adopted the concept of bacterial Infection to

explain ther Illness. The patients Identified their illness

with a variety of different labels, some of which had

associations with particular symptoms. Leprosy was

perceived and experienced more as a

series of acute disorders not necessarily related to one

another. The various theories of illness were

instrumental in directing treatment choices which

Included a number of indigneous healing practices.

Such informtlon may be useful in improving patent

care and compliance by providing practitioners with

Interpretive strategies for communicating with their

patients.

NIGHAM, P. et al. Male gonads in leprosy - a clinico-

pathological study. Indian J. Leprosy,

80(1):77-83, 1988.

ABSTRACT - Sixty male leprosy patients (mean

age 27.2=5.04 years) selected at random, were

studied for gonadal involvement with the mean

duration of illness 4.17=3.27 years. Only lepromatous

and borderline leprosy cases developed testicular and

epididymal changes. Testicular pain and/or swelling

(lepromatous 62.5%, borderline 30%) was the main

presenting feature. Altered sexual function was

observed in 34(56.6%) cases, and 11 patients

revealed altered sexual hair pattern. Gynecomastia

was seen In 9 cases. Reduced testicular size along

with Its soft feeling wass present In 25% of cases

while no testicular sensation was felt In 8 (13.3%)

cases, and impaired testicular sensation in 9 (15%) of

them. Spermogram revealed azoospermia In 19 (35%)

and oligospermia in 16 (26.6%) cases. Histopathology

revealed evidences of leprous pathology Irrespective

of testicular size, semen picture and clinical

manifestations. There was marked variation in

histopathological findings in testes and hence it was

difficult to categorise them into vascular, intestitial and

obliterative phase.

NILSEN, R. at al. The role of nerve biopsies in the

diagnosis and management of leprosy. Leprosy

Rev., 60(1): 28-32, 1989.

SUMMARY - Skin and nerve biopsies from 81

Hansen. Int 14(2): 133-150, 1989.

144
patients clinically suspected to have leprosy were

studied. Histologically 54% of the patients showed

leprosy. Both nerve and skin biopsies were

histologically diagnostic of leprosy in 64% of these

cases while 32% were diagnostic in the nerve but not

skin biopsy. In the 11 patients with multibacillary

leprosy (BI>2) a multibacillary picture was seen in all

nerve biopsies while 8 patients exhibited a

paucibacillary leprosy of the skin and a multibacillary

leprosy in the nerve. The present results emphasize

that leprosy is a disease of peripheral nerves and that

diagnostic criteria other than skin parameters is

important to reach a proper diagnosis. The evident

possibility of having patients with a multibcillary

leprosy in peripheral nerves and paucibacillary in skin

emphasize the need for clinical studies to clarify the

criteria for the diagnosis of paucibacillary leprosy and

the drug regimen for this group of patients.

NOORDEEN, S. K. The challenge of leprosy. /Editorial/.

Indian J. Leprosy, 80(2):149-158, 1988.

It gives me great pleasure to be able to

participate in the XV Biennial Conferece of the Indian

Association of Leprologists here this beautiful city of

Vishakapatnaum, and meet many of my old friend and

colleague. I am grateful to the organizers of the

Conference for making it possible. The Indian

Association of Leprologists is the largest and one of

the most important professional groups in the field of

leprosy in the world today, and I recall with pride my

close associations with IAL till a few years ago. In fact

the growth and development of IAL rightly reflects the

immense growth and development of leprosy work in

India in recent years.

What exactly are the challenges facing leprosy

and leprosy work today. In what way are they

different from the challenges faced in the past? There

is no doubt that the basic challeges remain the same

but the emphasis in several areas has changed

substantially. To understand this better It is important

Hanseníase: Resumos/Hanseníases Abstract - CLÍNICA 145

to take into consideration some of the achievements

In recent years that have benefited or promises to

benefit leprosy work.

PARIKH, D.A. et al. Penile and scrotal lesions In

leprosy: case reports. Leprosy Rev.,

80(4):303-305, 1989.

SUMMARY - Six leprosy patients in the Ridley-

Jopling spectrum of BT-BL showing lesions on penis

and scrotum are presented, as we believe that this

common enough clinical feature is not well

documented in the literature.

PATKI. A.H.; JADHAV, V. H. & MEHTA, J.M. A study

of dermatological conditions in leprosy in-

patients. Indian J. Leprosy, 61(1): 92-95,

1989.

ABSTRACT - Three hundred and sixty six In-

patients in a leprosy hospital were examined for other

dermatological conditions. Eighty eight of them

displayed ichthyosiform changes. A peculiar condition

of a verrucous hyperkeratotic growth on the anterior

aspect of ankle, not describe previously, was

observed in four patients. It was noted that 11 out of

12 patients with scabies did not have the classical

lesions in the spaces of the hands.

PATNAIK, J.K. et al. Hepatic Morphology in Reactional

States os Leprosy. Int. J. Leprosy, 57(2):499-505,

1989.

SUMMARY - Liver function tests and liver

biopsies were studied in 23 leprosy patients in

reaction and 10 without reaction. The liver biopsies in

leprosy patients with reaction showed exudative

lesions, epithelloid and tuberculoid granulomas, and

foam-cell granulomas. Portal vasculitis was

encontered in a few cases. Neutrophilic infiltration

Hansen. Int 14(2): 133-150, 1989.

into the foam-cell granulomas was seen In a few

cases of lepromatous (LL) leprosy with reaction. In

six cases of borderline (BL,BB and BT) leprosy with

reaction, a spectrum of lesions bearing footprints of

exudative lesions were seen evolving Into epithellold-

cell granulomas. Foam-cell granulomas and

tuberculoid and epithelioid granulomas along with

exudative lesions were encountered In two cases on

Individual biopsy strips. An altered albumin-to

globulin ratio was the chief functional derangement

observed in these cases. The spectrum of changes

observed in borderline leprosy with reaction could be

discrete steps in the evolution of upgrading reaction.

PAVITHRAN, K. Chromoblastomycosis in a residual

patch of leprosy. Indian J. Leprosy, 80(30):

444-047, 1988.

ABSTRACT - A middle age male who had

adequate dapsone monotherapy for borderline

tuberculoid leprosy developed chromoblastomycosis

within the residual analgesic patch during the post-

treatment follow up period. Claddsporium carrionli,

the causative fungus was isolated from culture in

Sabouraud's agar. There was prompt therapeutic

response to oral ketoconazole. The possible factors

for development of chromoblastomycosis in this

patient are discussed.

PAVITHRAN, K. Vitiligo following type II lepra

reaction. Indian J. Leprosy, 61(1):44-48,

1989.

ABSTRACT - A middle-aged male with

lepromatous leprosy developed bouts of skin lesions

of depigmented macules and patches of vitiligo, just

following attacks of type II lepra reaction each time.

In view of the present concept of autoimmunity

playing a role in the pathogenesis of vitiligo as well as

lepra reaction, their association in our patient

appears to be more than fortuious, the depigmented

macules persisted even after regression of skin of

leprosy following chemotherapy. The vitiligo macules

responded partially to topical and systemic psoralen

therapy.

QIN-XUE, Wu; GAN-YUN, Ye & XIN-Yu, U.

Serological Activity of Natural Disaccharide

Octyl bovine Serum Albumin (ND-OBSA) In Sera

from Patients with Leprosy, Tuberculosis, and

Normal Controls. Int. J. Leprosy, 56 (1):50-

55, 1988.

SUMMARY - We studied the natural

disaccharide-octyl-bovine serum albumin (ND-OBSA)

enzyme-linked immunosorbent asay (ELISA) in sera

from 151 leprosy patients, 20 tuberculosis patients,

and 42 normal persons from a nonendemic area.

The three ELISAs, whole Mycobacterium leprae

(WML), phenolic glycolipid-I (PGL-I), and ND-O-BSA,

are all highly sensitive for detecting antibodies

against M. Leprae. The results indicate that the

serological activity has higly significant, positive

correlations among the three types of antigens

used.Their positivity rates are 100% with PGL-I and

97.4% with WML and ND-O-BSA in leprosy patients,

and 0% with any antigen used in normal persons at

NV-a (a supposed theoretical normal value).

However, all three antigens show crossreactivity with

tuberculosis patients at different levels. At NV-c (a

suposed practical normal value, PNV), this

crossreaction significantly decreased in the WMKL

EUSA (PNV = 0.28) and the PGL-I EUSA (PNV 0.18),

and disappeared in the ND-O-BSA EUSA (PNV m

0.20). Under the same conditions, the same

conditions, the positivity rates did not decrease

significantly In leprosy patients, especially in

multibacillary patients. Therefore, we suggest that

the PGL-I EUSA in combination with the ND-O-BSA

EUSA may be very useful for clinical apllications,

serodlagnosis, and for the study of subclinical

infection in leprosy.

146

Hansen.Int.14(2):133-150,1989.


RAJAGOPALAN, M.S.; BALAKRISHNAN, S. & RAMU, G.

Sub clinical infection and the relative risk of

developing leprosy: a statistical approach.

Indian J. Leprosy, 61(2):169-172, 1989.

ABSTRACT - Subclinlcal infection in contacts of

leprosy patients was identified by FLA-ABS test and

Serum Antibody Competition Test (SACi). The risk of

developing leprosy and the confidence intervals were

worked out. The importance of expressing the risk

ratio and confidence interval of the tests is brought

out. This method is a useful adjunct to the routine

statistical methods in epidemiological studies.

RANGDAENG, S. et al. Studies of Human Leprosy

Lesion In Situ Using Suction-induced Blisters. 1.

Celluar Components of New, Uncomplicated

Lesions. Int. J. Leprosy, 57(2):492-498,

1989.

SUMMARY - The cellular contents of blisters

induced by suction over new, uncomplicated leprosy

lesions, and in the skin of cured, control patients,

have been examined with enzymend immuno-

histochemical staining over a period of 4 days. The

total cellularity of the blisters varied over a wide

range, not correlated with the type of leprosy.

Mononuclear cells predominated at all times studyed,

with nearly equal percentages of monocytes and T

lymphocytes. The T -helper: suppressor ratio was

significantly greater in BT than in BL and LL lesions at

48 hr. Suction blisters offer a painless, quantitative,

reproducible, multiple-sampling method for obtaining

cells from the cutaneous infiltrates of leprosy for

phenotyping or functional analysis.

RAO, T. & RAO, P.R. Serum immune complexes in

erythema nodosum leprosum reactions of

leprosy. Indian J. Leprosy, 60(2):189-195,

1988.

Hanseníase: Resumos/Hansen fasis Abstract - CLÍNICA 147

ABSTRACT - Serum estimations of

Immunoglobulins, complement components and

their presence in circulating immune complexes were

carried out in 39 Lepromatous, 44 ENL and 22 Post

ENL leprosy patients. Serum IgG, IgA, 19M, C3 and

C4 levels were determined by single radial

immunodiffusion. Serum immune complexes were

precipited with Polyethylene Glycol (PEG) and IgG,

IgA, 19M, C3 and C4 were estimated by single radial

immunodiffusion and expressed as % of precipitation

of their serum level. Decreased IgG, IgM; increased

IgA and C3; and no change in C4 levels are observed

in ENL than Lepromatous and Post ENL patients.

However, a gradual insignificant reduction of 19G,

IgA, and IgM was found from Lepromatous to ENL

and Post ENL patients in the PEG-precipitates.

Similarly, C3 and C4 was found reduced

insignificantly in ENL than Lepromatous and Post

ENL patients. The significance of these estimations

in relation to immune status of ENL reactions are

discussed.

RAZACK, E.M.A. et al. Multicentric

reticulohistiocytosis masquerading

lepromatous leprosy. Indian J. Leprosy,

60(4):604-608, 1988.

ABSTRACT - a 23-year old male presented for

evaluation of skin coloured, non-scaly, asymptomatic

papulonodules of sizes varying from 0.5 cm to 2 cm

of 4 years duration distributed all over the body

including the ears. The plaques present on the face

gave the appearance of a leonine fades. Clinically

mistaken for lepromatous leprosy in reaction the

patient was treated with antileprosy and anti-

inflammatory drugs In 3 other centres for months

with no improvement. Systemic involvement included

painful swelling of both knee joints, pericardial

effusion, episcleritis and enlarged liver. Negative slit

smears for AFB from the nodules repeatedly and the

histology of one on the skin nodules clinched the

diagnosis of muiticentric reticulohistiocytosis. The

Hansen. Int 14(2):133-150, 1989.

case is reported not only for Its rarity, and varying

clinical lesions simulating lepromatous leprosy but

also to alert the leprologists to avert unreasonable

delay In diagnosis.

REA, T.H. A Comparative Study of Testicular

involvement in Lepromatous and Borderline

Lepromatous Leprosy. Int. J. Leprosy,

56(3):383-388, 1988.

SUMMARY - To measure the comparative

prevalence of testicular involvement In borderline

lepromatous (BL) and lepromatous (LL) leprosy

patients, serum FSH, LH, and total testosterone levels

were measured in 42 LL and 21 BL subjects. Serum

FSH levels were elevated in 19% of BL and in 88% of

LL patients. Serum LH values were increased in 10%

of BL and In 79% of LL patients. Total serum

testosterone values below the normal limit of 280

ng/dl were not found In BL subjects but were present

in 31% (13) of the LL cases. By measuring serum free

testosterone in patients with low-normal total values,

one BL and an additional five LL patients could be

identified as below normal limits, i.e., <50 pg/mi.

Thus, androgen deficiency was present in 5% of BL

and 43% of LL subjects. All of these differences

between the BL and LL patients were statistically

significant.

SANE, S. 8. & MEHTA, J. M. Malignant

transformation in trophic ulcers in leprosy: a

study of 12 cases Indian J. Leprosy,

60(1):93-99, 1988.

ABSTRACT - Twelve cases of carcinomata

arising in Thophic ulcers of Leprosy are presented.

Out of these, 10 were on the plantar surface more

commonly on the proximal part of foot, one on lower

leg and dorsum of foot, and one in an ulcer over the

lateral malleolus. Almost all presented with Infected

growths and regional lymphadenopathy. Three cases

presented with advanced disease with fungatir.d

inguinal nodes and were fatal. Nine cases underwent

below knee amputation under antibiotic cover as a

definitive treatment and the lymph nodes were kept

under observation. Histologically, all were low grade

squamous cell carcinomas. In most cases lymph

nodes regressed after removal of primary and In one

case lymph nodes were positive for malignancy.

This study was conducted at Dr. Bandorawalla

Leprosy Hospital, Kondhawa, Pune 22 from the year

1981 to 1987.

SAXENA, N.; SHARMA, R.P. & SINGH, V.S. Study of

serun zinc level in leprosy Indian J. Leprosy,

60(4):556.561, 1988.

ABSTRACT - Serum Zinc level was estimated in

different types of leprosy by "Dithiazone extraction°

method In 75 leprosy patients comprising 15 each of

Tuberculoid - Tuberculoid (TT); Borderline

Tuberculoid (BT); Borderline Borderline (BB):

Borderline Lepromatous (BL) and Lepromatous

Lepromatous (LL). These findings were evaluated in

comparison to 15 normal subjects serving as

controls. Serum zinc level was observed to be

significantly low in all types of leprosy except

tuberculoid leprosy (TT). No significant difference

was observed in serum zinc levels before and after

90 days of dapsone therapy. The findings of our

study are of considerable importance as zinc

deficiency can be one of the factors involved in non-

specific supression of cell mediated Immunity (CMI)

In lepromatous leprosy.

SEN, R. et al. Bacillaemia and bone marrow

involvement in leprosy. Indian J. Leprosy,

61(4):445-452, 1989.

ABSTARCT - Fifty patients (24 new and 26

receiving specific treatment) of leprosy were

investigated to study the concentration and

Hansen. Int. 14(2):133-150, 1989.

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148
morphological index (MI)of the lepra bacilli in skin,

peripheral blood and bone marrow. The organisms

were detected in 28 skin slit smear examination, in

38 cases on bone marrow examination and in 38

cases on smears made from buffy coat of peripheral

blood. Out 22 cases negative for the bacilli on skin

slit smears, 15 had the organisms either in buffy

coat or bone marrow or both. Acid fast bacilli in

peripheral blood and bone marrow with skin smear

negativity were mainly observed in patients with

paucibacillary type of the disease and In those who

were receiving treatment. Examination of buffy coat

and bone marrow for presence of lepra bacilli is

suggested to establish the diagnosis in doubtful

cases.

SIDDAPPA, K. et al. Calcification of ulnar nerve in a

patient with tuberculoid leprosy - a case report.

Indian J. Leprosy, 61(1): 107-110, 1989.

ABSTRACT - A case of Tuberculoid Leprosy who

showed Evidence of Calcification of Right Ulnar

Nerve at Elbow on radiological Examination is

reported.

SIRUMBAN, P. et al. Diagnostic value of cardinal

signs/symptons in paucibacillary leprosy.

Indian J. Leprosy, 60(2): 207-214, 1988.

ABSTRACT - With the help of sensivity and

pecificity criteria, an attempt is made to quantify the

ain in certainty in diagnosis with the use of various

ardinal signs/symptoms (S/s) of leprosy in order to

tudy their predictive value in correct diagnosis of

aucibacillary leprosy (PB) by the Paramedical

orkers. The study was based on the findings in 326

ew cases of paucibacillary leprosy detected by 10

aramedical workers durign a recent field survey.

bservation in the present study confirm the scientific

asis of presently used combinations of cardinal S/s

or correct diagnosis of leprosy especially the

ombination of (skin) patch with


loss/impairment of sensation. The detailed

observations made in the study are discussed in this

communication.

SMITH, W.C.S. Are hypersensitivity reactions to

dapsone becoming more frequent? Leprosy

Rev., 59:53-58, 1988.

SUMMARY - Hypersensitivity reactions to

dapsone, which were common in the Iate 1940s and

early 1950s and then virtually disappeared, have now

reappeared in the last 5-6 years. Review of the

literature and a postal survey of centres using

dapsone on a mass scale confirms that the rection

has reappeared. The explanation for this is unclear

but may be related to the use of dapsone combined

with other drugs. These reactions are rare and some

centres treating large numbers of patients with

dapsone have not experienced any cases. Dapsone

must still be regarded as a safe preparation.

SONI, N.K. Epistaxis in leprosy. Indian J. Leprosy,

60(4): 562-565, 1988.

ABSTRACT - Forty-four leprosy patients with

epistaxis were analysed. Aetiopathogenesis of

epistaxis in leprosy is discussed in the light of

available literature. It has been suggested that

epistaxis is more frequent and severe in leprosy

patients and more liable to have complications.

Epistaxis in leprosy with nasal lesions may alarm the

physidam that patient has some systemic disorder.

SONI, N.K. Gustatory rhinorrhoea syndrome: result of

misreinnervation In leprosy. Indian J.

Leprosy, 60(3): 418-421, 1988.

ABSTRACT - A case of excessive rhinorroea in

response to taste stimulus, due to misdirection of

regenerating nerve fibres following recovery of facial

Hansen. Int. 14(2): 133.160, 1889.

nerve In leprosy is described under title of 'Gustatory

Rhinorrhoea Syndrome°. The pathophyslology of such

conditions are discussed in the light of available

literature.

SONI, N.R. Radiological study of the paranasal

sinuses in lepromatous leprosy. Indian J.

leprosy, 60(2): 285-289, 1988.

ABSTRACT - Thirty patients of lepromatous

leprosy have been studied by radiological

investigation for affection of paranasal sinuses. It has

been found that leprosy involves all groups of sinuses

and maxillary antrum is found to be more commonly

affected. Diffuse hyertrophy type of lesion is more

commonly recorded In maxillary antrum, in x- ray of

paranasal sinuses. The clinical significance and

importance of extension of disease in the sinuses is

discussed in the light of available literature.

SOSHAMMA, G. & SURYAWANSHI, N. Eye lesions

in leprosy. Leprosy Rev., 60(1)33-38, 1989.

SUMMARY - Out of 742 out-patients screened

for ocular disease, 177 (24%) had eye lesions due to

leprosy. These were more in the lepromatous

spectrum of the disease and showed increasing trend

with age of patient and duration of the disease.

Madarosis was the commonest lesion (76%). The

serious and. Sight threatening lesions like

lagophthalmos, corneal anaesthesia, corneal opacities

and ulcers, iritis and complicated cataract constituted

8-22% of the lesions. Blindness due to comeal opacity

and complicated cataract developed in 8 patients,

constituting 3-4% of eye lesions with a prevalence

rate of 0-8% among all the leprosy patients. Although

the blinding lesions occurred in a very small

percentage of patients, most of these are preventable

through early recognition and Institution of

appropriate treatment. The simple techniques of

examination to detect protentiaiy sight threatening

lesions should be taught to all leprosy workers to

prevent blindness among leprosy patients.

SRINIVASAN , H. & SUMPE, B. Value of thermal

sensibility testing In leprosy diagnosis In the

field - field trial of a pocket device. Leprosy

rev., 80(4):317-326, 1989.

SUMMARY - A handy thermal sensibility testing

device has been developed and field tested in

different centres in Africa and India The device

performed satisfactorily under field conditions and

made testing for thermal sensibility In the field

practicable and easy. Examination of the results of

testing 260 persons, most of them having a few

lesions of early leprosy, showed that the expected

Increase in the rate of diagnosis of sensory

impairment in the skin lesions, and so in the

diagnosis of leprosy, would be about 15-25% when

thermal sensibility testing using this device was

added to the other sensibility tests routinely used in

the field. Regular use of this device in the field will

help to bring more leprosy patients under treatment

than at present.

TALWAR, S. Spina bifida occults with atrophy of

toes. Indian J. Leprosy, 80(2):306-308,

1988.

ABSTRACT- A case of lumbosacralspinabifida

occults presented with resorption of toes which

started at six years of age. Its differential diagnosis

with neural leprosy is discussed.

THANGARAJ, H. et al. Epidermal Changes in

Reactional Leprosy: Keratinocyte Ia Expression

as an Indicator of Cell - mediated Immune

Responses. Int. J. Leprosy, 56(3):401-407,

1988.

150

Hansen. Int. 14(2): 133.150, 1989.


SUMMARY - Significant epidermal changes were

observed In lesions of leprosy patients undergoing

type 1 (reversal) and type 2 (erythema nodosum

leprosum, ENL) reactions. Using indirect

immunofluorescence and frozen sections stained with

the appropriate monoclonal antibodies, an increase in

epidermal cell layers, the presence of la on

keratinocytes, an Increase in Langerhans'cell

numbers, and scattered T cells within the epidermis

were seen In both types of reactions. Although

borderline tuberculoid patients with type 1-reactions

showed the consistent presence of la on all

keratinocytes, lepromatous patients undergoing ENL

reactions showed only a patchy distribution. Taken

together, these studies Indicate that local T-cell

activation leading to the production of terminal

lymphokine,such as Interferon-gamma, with

subsequent induction of la on epidermal cells may be

an important event in reactional leprosy states. It Is

of interest that the hitherto considered “anergic”

lepromatous patients should recover temporary T-cell

reacticity during the natural course of the disease.

VAISHNAVI, C. et al. Leprosy and hepatitis B surface

antigen. Indian J. Leprosy, 61(2): 211-215,

1989.

ABSTRACT - An EUSA technique has been

developed to detect HBsAg in the sera of leprosy

patients. Out of ninety-two serum samples taken from

untreated leprosy patients, 10 samples were positive

for HBsAg. The EUSA used In the present

Investigation is a low cost, reliable and sensitive

marker of HBsAg. It is better than lesser sensitive

(haemagglutination and counterimmuno

electrohoresis), costly and hazardous

(radioimmunoassay) techniques and is therefore

recommented for routine use.

AYTERKIN, A.H. & SAYLAN, T. Leprosy in

Turkey. Leprosy Rev., 59:231-234, 1988.

SUMMARY - An account is given of the historical

development of leprosy work and control measures in

Turkey. Detailed information is recorded on the

distribution of the disease according to year of

registration; age; sex; classification. After through

examination of the patient registers and other

sources of information, it can now be confidently

stated that reliable data exist for a total of 3851

leprosy patients in Turkey. Studies of distribution of

cases in the provinces and regions reveal some

curious discrepancies between areas of high and low

prevalence, not explained by socio-economic or other

factors. The systematic examination of registers and

other records, as described in this article, may be of

value in other countries, especially when the

incidence rate is decreasing, in defining the overall

problem and maintaining the interest of health

authorities and personnel.

BHATKI, W.S. Case detection; are the present survey

methods effective? A review of leprosy surveys

in Bombay. Leprosy Rev., 59:239-244, 1988.

SUMMARY - The results of active surveys carried

out in Bombay during the last 15 years show that

such surveys predominantly detect non-infectious

cases with 1-2 skin lesions. Considering the work

input in terms of field workers' days required to

detect each case, particularly an infectious case, the

present survey methods are not cost effective. Health

education is found to be more effective and efficient

in case detection than active surveys.

Modified methods which can identify infectious

cases at an early stage are discussed and suggested.

CHATURVEDI, R.M. Epidemiological study of leprosy

in Malwani suburb of Bombay. Leprosy Rev.,

59:113-120, 1988.

SUMMARY - The present investigation was

undertaken to study epidemiology of leprosy in

Malwani, a western suburb of Bombay, which has a

population of 63,321. A total of 691 cases were

detected in a 4-year follow-up period between April

1979 and April 1983. The prevalence rate in school

children was 13.88% and the peake incidence

occurred in the age group 10-19 years. In this study,

the females predominated the males with the male to

female ratio being 1:1.33. The disease was found to

be more prevalent in the low socio economic group

and in overcrowded families. Extremities were most

commonly affected. A large number of cases

occurred in contacts of infectious lepromatous

patients. The exact reasons for this could not be

ascertained from this rather small sample. It could be

related to droplet infections or skin contact

DEWAPURA, D.R. The current state of leprosy control

activities in Sri Lanka. Leprosy Rev., 60(1):39-

44, 1989.

SUMMARY - In Sri Lanka the overall prevalence

of leprosy was 0.14 per 1.000 population and the

incidence 0.07 per 1000 population at the end of

1987. Although the endemicity is low in the island,

disease transmission has not yet been achieved as the

annual detection of new cases and the child rate has

been gradually rising. The major activities of the

leprosy control programme are case-finding, treatment

and defaulter retrieval, health education, rehabilitation

and training. The field programme is implemented

through 15 specially trained paramedical workers. In

addition there are 5 medical officers attached to the

Anti-leprosy Campaign. The Director of theAnti-leprosy

Campaign is in overall charge of the National Leprosy

Programme and is also project manager for the Sri

Lanka Emmaus Leprosy Control Project.

GOYDER, E.C. Leprosy control in a Bombay slum - a

general assessment. Leprosy Rev., 59:245-253,

1988.

SUMMARY - During the course of a medical

student elective period, the author collected data from

one of the largest leprosy control projects in the slums

of Bombay, where the disease is hyperendemic.

Particular attention was given to case-detection rates

over a period of 5 years, drop-out rates, disability-

deformity, stigma and socio-economic conditions. In

this retrospective study, carried out during a limited

period of time in one project, it seems that

compliance, regularity of attendance and utilization by

the patients of the excellent services offered all run at

a level which Is

Hanseníase: Resumos/Hanseníasis Abstracts - EPIDEMIOLOGIA E CONTROLE 151

Hansen Int. 14(2): 151-153, 1989

often disappointingly low. The current priority is for

improved case-holding and some of the factor needed

to bring this about are discussed.

JEYASEELAN, L & RAO, P.S.S. Determination of sample

sizes for epidemiological surveys using cluster

sampling technique. Indian J. Leprosy,

61(1):84-91, 1989.

ABSTRACT - Cluster sampling often provides a

convenient and low cost device, in epidemiological

surveys. The sample size needed under cluster

sampling is generally larger than that in an individual

based scheme due to the intra-class correlation

existing in a cluster. This intra-class correlation

coefficient is usually not known and some assumptions

or estimates are essential. The strengths and

weaknesses of cluster sampling over other sampling

plans are presented and briefly discussed in this paper

with particular reference to leprosy control

programmes. One particular model of multistage

cluster sampling technique Is suggested in the

evaluation of a District level programme, which

includes determining the effectiveness of Multi-Drug

Therapy, monitoring efficiency of paramedical workers

and estimating the incidence of leprosy.

KAUR, P. et al. Epidemiology of leprosy in tribals of

Adhaura plateau. Indian J. Leprosy, 60(4)577-

580, 1980.

ABSTRACT - A door to door survey was carried

out in the Adhaura plateau of Bihar, to find out the

magnitude of leprosy problems in that area. Out of a

total of 7,521 persons, mostly tribals, 5,476 were

examined giving a coverage of 72.8%. Prevalence rate

of leprosy was 20.6%/1000 population. Maximum

prevalence was seen in the age group of 55 and

above. The disease was more common In males and

In the literate and educated group. The ratio of

tuberculoid was 57.5% borderline 29.0% and

lepromatous 10.0%, indeterminate type constituted

3.5%. The population had a poor nutritional status

with caloric intake of 1471 cal per day.

LORETTI, A. Leprosy control: the rationale of

integration. Leprosy Rev., 60(4):306-316 1989.

SUMMARY - After considering the situation

Hansen. Int. 14(2): 151-153, 1989.

152
and the perspectives of integration and the drawbacks

that a vertical approach can represent for leprosy

control, the author proposes the framework of control

programmes as a systemic model for comprehensive

health care. The structure that health services In

developing countries are adopting in order to

implement PHC allows for an horizontal integration of

specific activities: conversely, activities which have

already proved their value for leprosy control can

easily enlarge their scope and include other prevalent

conditions, Integration leads to an improvement In

patients and health workers' attitudes; provided that

the necessary supervision is guaranteed, integration is

feasible and warrants more effective patients' care and

a better exploitation of resources In order to reduce

the specific risk in the community.

MISHRA, R. S.; RAMESH, V. & NIGAM, P.K. Leprosy in

low endemic areas of India: an appraisal and

suggested measures for control. Indian J. Leprosy,

61(3):345-350, 1989.

ABSTRACT - Prevalence of leprosy in the low

endemic areas of India is described based on the

observations of patients attending an Urban Leprosy

Centre in the Union Territory of Delhi from the

neighbouring states. The rising incidence in these so-

called low to moderate endemic places Is closely

linked to factors related to urbanisation, movement of

people in search of employment, etc., which

necessitate fresh surveys in these areas. A significant

number of leprosy patients attending the Centre were

irregular (37.7%) in therapy and many absconded

after the initial visit (35.3%), the reasons for which

are discussed. These figures are compared to that

from similar low endemic areas and known high

endemic parts of the country. Suitable modifications to

the control programme in these areas are suggested

under the Purview of the National Leprosy Eradication

Programme.

NADKARNI, N. J. et al. Childhood leprosy in Bombay: a

clinico-epidemiological study. Indian J. Leprosy,

60(2):173-188, 1988.

ABSTRACT - During the years 1976-1985, 2138

cases of leprosy were detected in children aged 0-14

years, in L and M wards of Greater Bombay. Out of these,

records of 1084 patients were available for detailed

analysis. These were mainly from the deprived sections of

society. Most cases were detected through surveys,

though in recent years, there is an increasing trend for

voluntary reporting. The relevant epidemiological and

clinical findings are presented and compared with the data

of other workers in this field.

REVANKAR, C.R. et al. Leprosy survey in industries in

Bombay. Indian J. Leprosy, 61(3): 367-372 1988

SUMMARY - Population surveys for leprosy in

industrial cities like Bombay revealed that about 60% of

adult subjects especially males could be examined. The

fact that the prevalence rate of leprosy particularly

multibacillary type is much higher in this segment of

population as compared to other groups indicates the

importance of examining this population at their workspot

like industries.

22287 industrial workers were examined for leprosy

by paramedical auxiliaries in their establishments and 270

leprosy cases were detected (P.R. 12/1000). However,

only 13 muitibacillary cases (P.R. 0.5/1000) could be

unearthed. 12 patients were with grade II and above. 184

(83%) were untreated. 161 (60%) patients reported for

treatment.

With available resources, case holding of patients

who are not within the control area of the project

becomes a challenging job for paramedical workers

though large number of leprosy cases are detected

amongst industrial worker. If industrial management

arranges treatment for leprosy patients without dislocating

them from their service, the pool of infection in the urban

community will be reduced and can contribute

tremendously towards urban leprosy control programme.

REVANKAR, C.R. et al. Management information system

for leprosy eradication programme – an alternative

information system. Leprosy Rev, 60(2):129.134,

1989.

SUMMARY - For efficient monitoring of

multidrug therapy programmes for leprosy both at

microlevel (individual patient monitoring) as well as

macrolevel (programme monitoring), DANIDA

decided to develop an alternative, simple and quick

information system using a computer. A patient

data base system was designed using dBase Ill

package. The field workers of the National Leprosy

Eradication Programme were trained in transcribing

data on to coded data sheets. The data of 1750

patients of six leprosy control units from the 4 MDT

districts were processed and feedback reports were

sent to paramedical workers and programme

managers. The initial experience in the field over

the past year has shown that a computerized

management information system is feasible and

well accepted by the field staff for the purpose of

improving monitoring.

PONNIGHAUS, J.M. at al. The Lepra Evaluation Project

(LEP), an epidemiological study of leprosy in

northern Malawi. II: Prevalence rates. Leprosy

Rev., 59:97-112, 1988.

SUMMARY - Prevalence data obtained during a

population survey carried out by the Lepra

Evaluation Project (LEP) in Karonga District in

Northern Malawi (Central Africa) are presented and

analysed. Three different prevalence measures are

presented: of individuals with current clinical

leprosy who are likely to benefit from (further)

antileprosy treatment (the 'clinical' prevalence rate),

of individuals with either current clinical leprosy or

residual signs only (the 'visible' prevalence rate),

and of individuals with any physical or historical

evidence of present or past leprosy (the

'cumulative' prevalence rate). Effects of past

treatment and leprosy control efforts come to light

in the difference between the 'visible' rate and the

'cumulative' rate and Indicate that about 61% of

the leprosy patients In this area who have received

antileprosy treatment in the past, from the Lepra

Control Project, are now without remaining signs of

clinical leprosy. Past BCG vaccination campaigns

and active case finding through school surveys

appear to have affected the current age and sex

patterns of the disease. Prevalence rates are higher

among females than males in the older age groups.

The paper demonstrates how the observed pattern

and extent of leprosy are a function of the

prevalence measure used.

Hansen Int. 14(2):151-153, 1989

Hanseníase: Resumos/Hanseníasis Abstracts - EPIDEMIOLOGIA E CONTROLE 153

154 Hanseníase: Resumos/Hanseníasis Abstracts - GENERALIDADES

FOSTER, R.L. Nutrition .in Leprosy: A Review.

/Editorial/ Int. J. Leprosy, 56(1):66-81, 1988.

SUMMARY AND CONCLUSIONS - The literature

relating diet to leprosy is abundant between 1900 and

1960, peaking around 1940. Dietary factors that

appear to influence the etiopathogenesis of Hansen's

disease include:

vitamin A

vitamin B group

vitamin C vitamin D vitamin E calcium

zinc

We noted a frequent lack of detailed dietary data

in much of the literature cited. This is particularly true

when the thrust of the investigation is not dietary.

The literature strongly suggests the beneficial

influence of adequate diet on the outcome of Hansen's

disease and the deleterious effect of a deficient diet.

In contrast with the paucity of reported hard data in

the previous reviews concerned with the effect of

nutrition and diet on leprosy, is the increasing volume

of literature reviews and experimental studies showing

the profund impact of nutrition and diet on the

Immune system of man and laboratory animals.

That diet has a global, if poorly understood,

effect on the immune system is being increasingly

recognized. The difficult question that remain is how

to use this information in the control and prevention of

disease. Therefore, we believe that more emphasis

should be given to diet in the study of this important

worldwide disease in light of the current

understanding of biochemistry and immunology.

RAO, K.N. & SAHA, K. Undernutrition and Iepromatous

leprosy. Serum vitamin A and E levels in leprosy

spectrum. Indian J. Leprosy, 60(1):66.70, 1988.

ABSTRACT - Serum vitamins A and E were

estimated by spectrophotocolorimetric methods in 67

leprosy patients comprising 9 BT, 10 BB, 15 BL, 27 LL,

including 12 Histoid cases. These findings were

evaluated in comparison to 55 normal subjects serving

as controls. A significant reduction in the mean serum

levels of Vitamins 'A' and 'E' were observed in the

leprosy groups as compared to normal controls. These

findings are of considerable importance and need to

be taken nota of in the light of delineating these

alterations to the cause or effect of the disease. As far

as we know, this is the first report discribing serum

levels of Vitamins 'A' and 'E' in the leprosy spectrum.

SHEELA, G.R. at al. Leprosy teaching in medical

colleges in Bombay - a questionaire study. Indian J.

Leprosy, 61(2):233.237, 1989.

ABSTRACT - An attempt was made to study the

adequacy of leprosy teaching, at the undergraduate

level of the four medical colleges In Bombay, and to

suggest possible routes towards the reorientation of

leprosy teaching.

Over 55% of the medical faculty contacted

expressed dissatisfaction with the existing pattern of

leprosy teaching.

The survey reveals ample evidence pointing to

the necessity of redesigning the curriculum at the

undergraduate level, so as to provide increase

weightage to both the theoretical and the practical

aspects of leprosy. A heartening feature of the study

Is the inclination shown by a majority of medical

teachers to associate themselves with the PSM

Department in order to help improve leprosy teaching

and thereby help in leprosy control. This offer should

definitely be taken advantage of for furthering the

cause of leprosy eradication as a part of achievement

of "Health for All by 2000 AD".

TARE, S.P. A Review of Health Education in

Leprosy. /Editorials/ Int. J. Leprosy, 56(4):611-618,

1988.

SUMMARY - Leprosy of Hansen's disease Is an

age-old problem that has yet to be completely

controlled. It is estimated that there are between

Hansen. Int. 14(2):164-155, 1989.

http://R.L.Nutrition.in

10-12 million leprosy cases in the world. However,

only half the number of world leprosy cases were

registered as of 1985. Leprosy may be viewed as a

risk in areas where the prevalence of cases is over 1

per 1000. Therefore, 56 countries in the world may be

thought of as at risk for leprosy. Health education is

an integral part of leprosy control. Unfortunately,

health education is often underrated in value and

misunderstood as to its proper place in leprosy disease

control. Joshi says "the present day leprosy control

programme is based on three activities namely survey,

education (regarding health) and treatment." Joshi

further states that "treatment is emphasized equally

by all, but regarding survey and health education it is

observed that most of the workers emphasize only on

survey and practcally neglect health education work."

STES, P. & MALÂTRE, X. Will the leprosy endemic in

Rwanda soon be under control? Leprosy Rev.,

60(2): 139-146. 1989.

INTRODUCTION - It appears that leprosy in

Rwanda is becoming a rather rare disease. By the end

of 1987, 1142 cases were still under treatment, a

prevalence rate of 0.17 per thousand. Prevalence rates

declined from 0.26 per thousand in 1982, by an

average of 0.018 per thousand a year. However, it is

necessary to know whether the number of known

patients reflects reality, and if case finding has been

adequate. In other words: has the detection rate been

a reliable indication of the incidence rate? This paper

studies the problem, and tries to see if any conclusions

can be made about the transmission of leprosy in the

Rwandan population.

In the past, it has been suggested that a

prevalence survey would be the most accurate way to

evaluate leprosy prevalence. A preliminary study of

the project however showed that, if we wanted to

obtain acceptable margins of error, the sample to

examine would be of about 225,000 persons. A survey

of such size would be costly in time, money and

personnel. Unfortunately, these disadvantages would

outweigh any advantages to be gained from this

procedure. So, we had to look for other methods to

evaluate the importance of the leprosy problem in

Rwanda, and particularly evaluate some

epidemiological indices relating to the incidence rate.

SYLAN, T. at aI. The characteristics and mode of

detection of the new patients encountered in the

leprosy endemic province of Van within the last

five years. Indian J. Leprosy, 61(2): 225-228,

1989.

ABSTRACT - Between 1983-1987, the Istanbul

Leprosy Centre (ILC) organized in Van a leprosy

education program for medical personnel and the local

population. Subsequently whole population surveys

and case contact surveys were carried out

independently in different regions.

66 new cases were detected during those years

56(85%) patients were diagnosed by ILC teams at the

field and at the hospital.

in 49 (74%) of the 66 there was one or more

close contact within the family, in 17 (26%) there was

none, but old patients in the village or nearby.

It is concluded that the education of the local

medical authorities and the population is of utmost

importance for the early diagnosis and patient-close

contact surveys are the best for our contry.

Hanseníase: Resumos/Hanseníasis Abstracts - GENERALIDADES 155

Hansen. Int 14(2): 154-155, 1989.

CREE, I.A. et al. Reproducibility of Histology in

Leprosy Lesions. Int. J. Leprosy, 56(2):297-

301, 1988.

SUMMARY - The variability of three commonly

used histological parameters In leprosy histology was

examined within and between lesions on individual

patients by taking two biopsies, either from opposing

edges of the same lesion or from the edge of two

separate lesions. There was little variation in

granuloma fraction (GF), bacterial index (BI), or

histological classification on the Ridley-Jopling scale

between biopsies from opposing edges of the same

lesion, but there was considerable variation in the GF

between biopsies from the edge of different lesions.

A lesser degree of variation was seen in the BI

between different lesions, and there was little

difference in histological classification between

established lesions. Thus, it appears that local factors

influence the size of the leprosy granuloma, but its

histological composition and bacterial load are

determined systemically.

JOB, A. & CHACKO, C.J.G. Reactional States in the

Nasal Mucosa: A Clinical and Histopathological

Study. Int. J. Leprosy, 56(4):523-526, 1988.

SUMMARY - Twenty leprosy patients in the

reactive phase of the disease were studied clinically

and histologically for evidence of reactive lesions in

the nasal mucosa. Ten of 4 patients with erythema

nodosum leprosum (ENL) showed characteristic

polymorphonuclear leukocytic infiltration and two

patients showed vasculitis. The histological changes

of reversal reactions in the nasal mucosa, one with

upgrading reaction and the other with downgrading

reaction, are reported.

MALATY, T. at al. Histopathological Changes in the

Eyes of Mangabey Monkeys with Lepromatous

Leprosy. Int. J. Leprosy, 56(3):443-448, 1988.

Hansen.Int. 14(2)158.157, 1989.

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SUMMARY - Leprosy is the third leading cause of

preventable blindness; however, little is known about

the spread of infection to the eye. We have studied

the eyes of three sooty mangabey monkeys. Two

were experimentally infected with Mycobacterium

leprae; the third was not infected. In one of the

infected animals there was histopathological evidence

of lepromatous leprosy as evidenced by a chronic

inflammatory infiltrate at the limbus, and detection of

acid-fast bacilli in the corneal stroma, blood vessel

walls, and corneal nerves. The latter were damaged

as a result of the bacillary invasion. Electron

microscopy revealed involvement and distortion of

keratocytes with M. leprae and invasion of the

corneal stroma by macrophages containing bacilli.

Both Infected animals showed focal collections of

lymphocytes in the superficial stroma of the

conjunctiva and in the ciliary body. This is the first

report of the ocular manifestations of leprosy in any

primate, including man, in which the duration of

infection is known.

MUKHERJEE, A. & MISRA, R.S. Comparative histology

of skin and nerve granulomas in leprosy

patients. Leprosy Rev. 59:177-180, 1988.

SUMMARY - Biopsies were taken from infiltratd

lesions and thickened nerves in 23 patients with

leprosy. The lesions were histologically graded and

the histological features semiquantitated and

compared at the 2 sites. No significant difference in

the overall histological picture in the skin and the

nerve was seen. Two features seen more in nerve

granulomas were caseation and a higher granuloma

fraction, neither of which was thought to have any

significant bearing on the comparative

immunohistological grading at the 2 sites.

ONNIGHAUS, J.M. & FINE, P.E.M. A comparison of

sensory loss tests and histopathology in the

diagnosis of leprosy. Leprosy Rev., 60(1):

20-27, 1989.

SUMMARY - Three different sensory loss tests,

or anaesthesia to light touch, for diminished pain

ensation and for loss of thermosensation, were

ompared with histopathological examination results in

he diagnosis of suspected tuberculoid leprosy in 120

ndividuals with 126 lesions. Though none of the 3

ests used in this study was found to be

strikingly superior to any of the others, the results

Indicate potentially important differences in their

usefulness in different subgroups of suspected

patients. The methodological problems inherent in

such studies are discussed.

SHENOI, S.D. & SIDDAPPA, K. Correlation of clinical

and histopathologic features in untreated

macular lesions of leprosy - a study of 100

cases. Indian J. Leprosy, 60(1):202-206,

1988.

SUMMARY - Clinical and histopathological

correlative studies carried out in 100 cases of leprosy

with macular lesions revealed an overall parity in

47% of the cases. Disparity was observed in TT, BT,

BB, BL and IL series but not in LL series. The variable

tissue response in the disease spectrum due to the

variability of CMI is responsible for the disparity in

various types of leprosy, irrespective of the type of

lesions, whether macular or elevated.

WABITSCH, K.R. & MEYERS,

W.M. Histopathologic observations on the

persistence of Mycobacterium leprae in the skin

of multibacillary leprosy patients under

chemotherapy. Leprosy Rev., 59:41-346, 1988.

SUMMARY - In the study of 782 biopsy

specimens from 195 patients during and after

chemotherapy we compared the numbers of

Mycobacterium leprae stained by the Fite-Faraco (FF)

and the Gomori methenamine-silver (GMS) techniques.

In many patients large amounts of non-acid-fast M.

leprae or remnants thereof remained 66 months after

starting effective multidrug therapy. The GMS stain is

a useful method for assessing the efficacy of methods

for enhancing bacillary clearance in multibacillary

leprosy patients.

Hanseníase: Resumos/Hanseníasis Abstracts - HISTOPATOLOGIA 157

Hansen. Int. 14(2)158-167.1888.

AGIS, F. et al. Use of anti-M. leprae Phenolic

Glycolipid-I Antibody Detection for Early

Diagnosis and Prognosis of Leprosy. Int. J.

Leprosy, 56(4):527-536, 1988.

SUMMARY - Untreated patients suffering from

tuberculoid, lepromatous and indeterminate leprosy,

their domiciliary contacts, and healthy controls, all

living in Guadeloupe, West Indies, were tested by an

ELISA for detecting IgM antibodies to the terminal

disaccharide of the phenolic glycolipid-I antigen of

Mycobacterium leprae. On most subjects, a Mitsuda

test was also performed. A large majority of the

tuberculoid patients and healthy subjects were

Mitsuda positive. The seropositivity rate reached 44%

among tuberculoid patients, and 6% among healthy

subjects, with low antibody levels. Lepromatous

patients were all Mitsuda negative and seropositive,

with antibody production varying from low levels, as

seen in tuberculoid patients, to much higher levels.

Indeterminate leprosy patients included 62%

Mitsuda-positive subjects and 54% seropositive

subjects with a large dispersion of antibody levels.

Comparing the results of the Mitsuda test to those of

the ELISA by factorial analysis allowed us to define

several subgroups among this population: some

(25%) showed a "lepromatous-like" immune status

(Mitsuda negative, seropositive); others (54%)

exhibited "tuberculoid-like" profiles (Mitsuda positive

without antibodies or with low antibody levels).

"Lepromatous-like" cases were

significantley older than "tuberculoid-like" patients. A

group of subjects (17%) was Mitsuda negative and

seronegative, thus displaying a true "indeterminate"

immune profile, which had not been seen in other

forms of the disease and had been observed in only 2

out of 51 healthy controls.

A large majority of contacts was Mitsuda positive,

with 33% of them being seropositive, indicating that

the prevalence of M. leprae infection greatly exceeds

that of overt leprosy in this population. Only a few

contacts displayed lepromatous-like immune responses

to M. leprae (Mitsuda negative, seropositive) or

exhibited an "indeterminate" pattern (Mitsuda

negative, seronegative).

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Hansen. Int. 14(2):158-189. 1989.


BIGGINS, T. et aI. T and B cells in borderline

(BB) leprosy. Indian J. Leprosy, 60 (1):21-25,

1988.

ABSTRACT - The response to standard

harmendra lepromin and the circulating T, B cell

umbers in the peripheral blood were quantitated in

5 patients with Borderline (BB) Leprosy. On the basis

f lepromin response, the patients fall into three

roups (a) negative (b) = reaction (c) rarely positive.

o significant difference in the numbers of E-rosette

nd EAC rosette forming cells was observed in the BB

atients in comparison to controls.

CHAKRABARTY, A.K. at al. Solubilization of

reformed Immune Complexes in Sera of Patients with

ype 1 and Type 2 Lepra Reactions. Int. J. Leprosy,

6(4):559-565, 1988.

SUMMARY - Serum complement activity in

eprosy patients has been studied using solubilization

f preformed immune complexes as an index. The

olubilization capacity of sera from lepromatous

atients with or without erythema nodosum leprosum

ENL) as well as from type 1 reactional patients was

ound markedly reduced as compared to controls.

olubilization did not improve at all in the ENL patients

fter remission of the reaction phase. The addition of

resh normal sera failed to bring about any significant

estoration of solubilizing capacity of the deficient

era. Mycobacterium leprae sonicate significantly

educed the solubilization capacity. Our results

uggest that circulating mycobacterial breakdown

roducts possibly interfered with the capacity of the

NL patients' sera to solubilize immune complexes.

Hanseníase: Resumos/Hanseníasis Abstracts - IMUNOLOGIA 159

CHIRMULE, N. B.; CHATUVERDI, R. M. & DEO, M. G.

Immunogenic "Subunit" of the ICRC Antileprosy

Vaccine. Int. J. Leprosy, 56(1):27-35, 1988.

SUMMARY - The administration of a vaccine

containing ICRC bacilli, which is currently undergoing

clinical trials in India, induces persistent lepromin

conversion in lepromatous leprosy (LL) patients and

lepromin negative healthy subjects, with "upgrading"

of tissue response in the former. A sonicate of ICRC

bacilli, when subjected to gel-filtration

chromatography using high-pressure liquid

chromatography (HPLC), yields a high molecular

weight glycolipoprotein (PP-I) with an apparent

molecular weight of 106 daltons. PP-I, which brings

about lepromin conversion in lepromin-negative

healthy subjects, is a major immunogen of the

organism, and carries epitopes for both B and T cells.

A similar high molecular weight glycolipoprotein (PP-I

Mycobacterium leprae) has been isolated from the

sonicate of M. leprae. The two PP-I fractions exhibit a

close antigenic relatedness at both B- and T-cell

levels. However, they differ in their chemical

composition and carry different charges.

PP-I of ICRS is not only a good immunogen. Its

high lipid content provides the necessary built-in

adjuvant that would make it a good candidate for a

"subunit" antileprosy vaccine. Also, since it carries

epitopes for both B and T cells, PP-I ICRS could be

used for "molecular engineering" to obtain molecules

which selectively stimulate T-cell immunity which is

the dominant host defense against M. leprae.

CREE, I. A. et al. Mucosal immunity to mycobacteria

in leprosy patients and their contacts. Leprosy

Rev., 59:309-316, 1988.

SUMMARY - Since the development of leprosy

may follow the formation of an initial lesion in the

nose, mucosal immune responses might be important

in the protective immune response to Mycobacterium

leprae. Salivary antibody responses to M. leprae and

other mycobacteria were therefore investigated in

leprosy patients and healthy contacts using EUSAs

against whole mycobacteria and an M. leprae-specific

glycolipid constituent (PGL1) of the external surface

of M. leprae. Lower levels of salivary IgA directed

against M. leprae were found In household contacts

(at high risk of developing

Hansen. Int. 14(2): 158-189, 1989.

leprosy) than in hospital contacts (low risk of leprosy).

Samples from the local indigenous population with no

know leprosy contact showed an intermediate number

of positive salivary IgA responses against M. leprae and

untreated patients were less likely to be positive than

treated patients.

Correlation was found between salivary antibody

responses to M. leprae, M. scrofulaceum and M.

tuberculosis, suggesting the presence of some

atssreacting antibody. Few patients and no healthy

subjects had detectable antibody responses against an

epitope of PGL1, suggesting that this important serum

antibody response is not a major component of the

mucosal immune response to M. leprae. Since there,

appears to be a secretory IgA response to M. leprae

which is least likely to be found amongst those with the

disease and in those individuals with increased risk of

developing leprosy, we suggest that the mucosal

immune system might be of importance in a putative

protective response to infection by the leprosy bacillus.

CREE, I. A. et al. Serum antibody responses to

mycobacteria in leprosy patients and their

contacts. Leprosy Rev., 59:317-327, 1988.

SUMMARY - The aim of this descriptive study was

to investigate the relationships between serum

antibody responses to different mucobacteria in

leprosy patients and contacts. The results of EUSAs for

serum antibody against whole mycobacteria

(Mycobacterium leprae, M. tuberculosis, and M.

scrofulaceum) were compared with the results of M.

leprae-specific ELISA for antibody against an epitope

of PGL1. The IgG response was found to be

predominant in ELISAs for antibody directed against

whole M. leprae, while the IgM response was greatest

in the assay for antibody against PGL1. Some healthy

hospital workers were found to have appreciable levels

of IgM anti-PGL1. Since infection in this group is

unlikely chronic exposure may result in humoral

(esponses to PGL1 in addition to subclinical leprosy.

None of the ELISAs studied were able to give greater

than a 55% sensitivity at 95% specificity and none

were considered suitable for serodiagnostic use.

Significant correlation was found between the

results from the whole mycobacterial EUSAs, which

could be explained on the basis of cross-reaction

between antibodies directed against common

antigens. However, similar correlations were found

between the results of the M, leprae-specific ELISA

and the assay for antibody against whole M.

tuberculosis and M. scrofulaceum which were greater

than those for antibody against whole M. leprae.

Infection with M. leprae may produce general

stimulation of immunological memory for common

mycobacteria; antigens resultign in responses to

antigens belonging to other mycobacteria to which

the host has been exposed previously.

DESFORGES, S. et al. Specific Anti-M. leprae PGL-I

Antibodies and Mitsuda Reactions in the

Management of Household Contacts in New

Caledonia. Int. J. Leprosy, 57(4):794-800,

1989.

SUMMARY - Household contacts of leprosy

patients have been tested for anti-phenolic glycolipid-

I IgM antibodies (anti-PGL-I IgM) by an ELISA using

the natural disaccharide (NDO) and natural

trisaccharide (NTO) synthetic antigens. A group of

healthy subjects without known exposure to

Mycobacterium leprae served as controls. The

percentages of positivity observed in multibacillaty

patients, paucibacillary patients, and household

contacts were significantly higher'than those of the

negative controls. The absorbance values using NDO

and NTO correlated well (range 0.59-0.91) when

analysis of each subject group was performed. As

reported here, NDO and NTO antigens seem to be

equal in detecting leprosy cases; 100% of

multibacillary and 21.43% of paucibacillary cases

were detected as seropositive. For the screening of

household contacts, NDO appears to be more

sensitive and NTO more specific. There were more

seropositive cases in the young age groups of

household contacts, suggesting a higher rate of

transmission of M. leprae infection in those age

groups. Lepromin and anti-PGL-IIgG tests were also

performed in contacts who were followed. The 2

paucibacillary subjects (1 borderline tuberculoid, 1

indeterminate) were Mitusuda negative. At diagnosis,

their anti-PGL-I IgM levels were much higher than

those of previous results: their anti-PGL-I IgG levels

showed an increase in one and a decrease in the

other. However, for the entire group anti-PGL-I IgM

and

160

Hansen Int. 14(2): 158-169, 1989


anti-PGLI IgG levels were positively correlated. The

data reported here suggest that an increase in specific

anti-M. leprae levels in Mitsuda-negative household

contacts could reveal the development of overt

disease.

DOUGLAS, J. T. et al. Evaluation on inexpensive

blocking agents for ELISA in the detection of

antibody in leprosy. Leprosy Rev., 59:37-43,

1988.

SUMMARY - In leprosy research, ELISA is

currently being used to quantitate antibody

concentrations in leprosy patients and their contacts.

The advent of Mycobacterium leprae specific synthetic

antigens has tremendously increased the sensittivity

and specificity of the detection system being used. It

allows researchers to monitor the effectiveness of

chemotherapy and also permits early detection of

lepromatous patients likely to spread the disease and

those contacts who have contracted it. The use of this

detection system has now gained popularity amongst

researchers in various contries throughout the world.

However, its use in some countries is still being

hampered by availabitlity and high costs of reagents,

particulary, blocking agents. We compared 5 blocking

agents commonly used and found 10% skimmed milk

or nonfat dry to be the most suitable. It is as effective

a blocking agent as those popularly used. It did not

adversely effect the pattern of the ELISA response

expected of high and moderate reacting sera. It is

relatively inexpensive compared to bovine serum

albumin (BSA) or normal goat serum (NGS), readily

available (it can be purchased at local grocery stores),

stable at room temperature and very simple to

prepare.

FAT, R. F. M. L A. et al. In Vitro Synthesis of

Antimycobacterial Antibodies with Different

Specificities in Various Tissues of Leprosy

Patients. Int. J. Leprosy, 58(4):552-558, 1988.

SUMMARY - For the detection of the synthesis in

vitro of anti-Mycobacterim leprae antibodies in various

tissues of leprosy patients, biopsy specimens of skin

lesions, nasal mucosa, larynx, lymph nodes, and bone

marrow were cultured in a medium containing 14C-

labeled lysine and isoleucine. The culture fluids were

analysed by crossed immuno-eletroctrophoresis with

Hanseníase: Resumos/Hanseníasis Abstracts - IMUNOLOGI A 161

intermediate gel and autoradlography. The results

show that synthesis of anti-M. leprae, antibodies

occurs at the investigated sites of leprosy patients and

that the speciflcities of the synthesized antibodies

differ between sites in individual patients. It Is

conceivable that these antibodies play a role in the

local defense against M. leprae.

FINE, P. E. M.; PONNIGHAUS, J. M.; BURGESS, P.;

CLARKSON, J. A. & DRAPER, C. C.

Seroepidemiological Studies of Leprosy in

Northern Malawi Based on an Enzymelinked

Immunosorbent Assay Using Synthetic

Glycoconjugate Antigen. Int. J. Leprosy,

56(2):243-254, 1988.

SUMMARY - A total of 6002 blood samples from

total population samples in. four separate areas within

Karonga District, Northern Malawi, were tested for

anti-Mycobacterium leprae antibody using an EUSA

based on synthetic glycoconjugate, antigen. Results

are presented using different criteria for seropositivity.

Regardless of the criterion used, the proportion of

individuals classified as "positive" rose to a peak at 20-

30 years of age and then fell, and it was higher at all

ages in females than in males. There was no

difference in seropositivity levels between individuals

with or without BCG scars. Although leprosy cases, in

particular those with positive smears, had higher

antibody levels than nonleprosy cases, analysis of age-

standardized data revealed only weak evidence for a

correlation between the prevalence rates of clinical

leprosy and of seropositivity within the four areas.

There was no evidence for higher seropositivity levels

in household contacs of leprosy cases compared to

noncontacts. The implications of these results for the

epidemiology of leprosy in this population are

discussed.

GANAPATI, R. et al. A Pilot Study of Three

Potential Vaccines for Leprosy in Bombay. Int- J.

Leprosy, 57(11:33-37, 1989.

SUMMARY - Three vaccines, BCG Glaxo alone

(vaccine A), BCG Glaxo plus 107 killed Mycobacterium

vacoae (vaccine B), and BCG Glaxo plus 107 killed M.

leprae (vaccine C), were given to groups of selected

children. The effects of these vaccines on subsequent

quadruple skin testing 1-3 years after vaccination were

compared. All three vaccines equally and significantly

(p - 0.00001 increased positivity to tuberculin, but on

vaccine B was found to significantly enhance

development of skin-test positivity to leprosin A (p -

0.00Z. The data support the evidence previously

obtained in rural Iran that the combinatin fo BCG with

killed M. vacrae is likely to be a better vaccine for

leprosy than is BCG alone.

GILL, H. K.; MUSTAFA, A. S. & GODAL, T. Vaccination

of Human Volunteers with Heat-Killed M. tepee:

Local Responses in Relation to the Interpretation

of the Lepromin Reaction. Int. J. Leprosy,

56(1):36-44, 1988.

SUMMARY - The early (Fernandez) and late

(Mitsuda) lepromin reactions were closely examined in

a group of healthy, BCG-vaccinated Individuals who

were given four doses of a heat-killed, armadillo-

derived vaccine, i.e., 1.5 x 107, 5 x 107, 1.5 x 108,

and 5 x 108 bacilli. There was a clear dose-response

relationship for both the early and late reactions with

no leveling of the responses with in the range of doses

examined. While the early response was negative in

most of the volunteers, the late response was positive

in all of the volunteers. No association was found

between the early lepromin test and the pre-

vaccination skin test to PPD. There was also no

association between the early lepromin test and the

pre-vaccination skin test response to a soluble

Mycobactenum leprae antigenic preparation (MLSA) in

general, but there was a good correlation between

these two parameters at the highest vaccine dose. The

late lepromin response showed no association with

either the pre-vaccination or post-vaccination skin test

response to PPD. However, there was a significant

correlation between the late lepromin response and

the post-vaccination skin test response to MLSA. In

general, no association could be found between the in

vivo skin tests and the in vitro lymphocyte

transformation test (LTT). Thus, the lepromin test Is

essentially a vaccination which elicits a specific

response to M. leprae antigens provided that the dose

of armadillo lepromin given is higher than 5 x 107.

Therefore, it is unsuitable as a diagnostic test for

leprosy. The variability of the early lepromin

responses, especially in the lower range of Iepromin

doses, precludes its use as a measure of previous

senstitization. However, the more consistent late

lepromin response.

GUPTE, M. D. & ANANTHARAMAN, D. S. Use of soluble

antigens in leprosy epidemiology. Leprosy Rev.,

59:29-335, 1988.

SUMMARY - Rees and Convit antigens preparedfrom armadillo-derived Mycobacterium leprae arepresently available. This study was undertaken tounderstand the skin test reactions produced by theseantigens in comparison to tuberculin. A standard testeskin-tested about 250 individuals. The indurationswere read at the end of 48h for Rees. and Convit andat the end of 72 h for tuberculin by a standard readerwho read these reactions following blind proceduresagain after 2 h. The values of standard deviations forthe mean differences were 1.0,2.6 and 2.4 mm fortuberculin, Rees and Convit antigens respectively.Standard deviations for the mean differences for twodifferent tests using the same antigen on the sameindividual twice, were 3.0, 6.0 and 5.3mmrespectively. Two batches of Rees antigen gavereasonably consistent results, but the skin-testreadings with 2 batches of Convit antigen differedsubstantially. The available antigens need furtherimprovement.

HASAN, R. et al. Quantitative Antibody ELISA for

Leprosy. Int. J. Leprosy, 57(4):766-776, 1989.

SUMMARY - Quantitative enzyme-linkedimmunosorbent assays (ELI SAs) were established tomeasure IgM and IgG antibody levels to solubleMycobacterium leprae sonlcate (CD60) and to thesynthetic disaccharide antigen based on the phenolicglyciolipld-I antigen of M. leprae coupled to bovineserum albumin in 46 leprosy patients. Separatereference pools for IgM and IgG antibody wereestablished. The reciprocal of the antibody titer wasexpressed as the number of arbitrary units in thereference pools which was subsequently used as thecalibrator for assessment of units in individual testsera. The dose-response relationship for both IgM andIgG was highly specific and reproducible for bothisotypes, as indicated by the intra-and inter assaycoefficients of variation. The distribution of antibodylevels are in general agreement with the results fromprevious studies against different M. leprae antigens.The lepromatous group showed 10- to 100-fold higherIgM anti-bodies to both the soluble sonicate antigenand the disaccharide as compared to the controlgroup. Very low to undetectable levels of

Hansen. Int. 14(2):168-169, 1989

162
IgM antibodies were observed In the tuberculoidgroup of leprosy patients. IgG antibodies, on the otherhand, were not only present but showed considerableoverlap with the lepromatous patient group.

Optimized ELISAs, such as the one described In thisstudy, would allow one to address Issues such asantibody changes with treatment, antigen clearance,and correlation with other immune parametersassociated with disease pathogenesis and protection.

KAUR, I. et al. Lymphocftotoxis in leprosy. Indian J.Leprosy, 61(2):184-168, 1989.

ABSTRACT - Lymphocytotoxic antibodies (LCAs)

were assayed in serum samples from 60 patients of

leprosy spectrum before starting multi-drug therapy

(MDT). Seventeen healthy volunteers without any

history of viral infection provided control samples.

Posttreatment follow up samples were also included in

the study.

In all pretreatment sera of LL, BL and BT/TTpatients the levels of LCAs were elevated, the figureswere 39.05 = 23.87, 44.89 = 20.74 and 34.16 =17.50 respectively. With treatment a significant fall inLcAS production was observed In all types of leprosypatients.

MOUDGIL, K. D. et al. Evaluation of an enzyme

immunoassay based on sonlcate supernatant

antigens of Mycobacterium W. for

immunodiagnosis of leprosy. Indian J. Leprosy,

60(2):159-172, 1988.

ABSTRACT - An enzyme immunoassay (EIA)based on sonicate supernatant antigens of acultivable, atypical bacterium, Mycrobacterlum w(M.w), for immunodiagnosis of leprosy Is described.M.w was selected after screening of sonlcatesupernatant antigens .of seven cultivable mycobacteriaIn EIA. The results of the assay were compared withthat of EIA using phenolic giycolipid-I (PGL-I). TheM.w assay was more


sensitive than PGL-I based EIA, for detection of

leprosy patients of all categories, including long term

treated patients with low bacterial load. The M.w

assay was highly sensitive (93.49%) for detection of

active LL patients, and the difference in the positivity

of the two assays for LL patients was statiscally

significant (p 0.05). The combined positivity of the

assays with M.w and PGL-1 for LL was higher than

that with either antigen alone. M.w assay, in addition,

was also highly sensitive for detection of patients with

active pulmonary tuberculosis.

MOUDGIL, K. D.; SINGH, G. & TAWAR, G. P. Detection

of lepromatous patients shedding M. Leprae in

nasal droppings by enzime immunoassay. Indian

J. Leprosy, 60(4):549-533, 1988.

Enzyme immunoassays (ElAs) for detection of

lepromatous leprosy (LL) patients harbouring M.

leprae in nasal mucosa are described. One EIA

measures IgM antibodies against the synthetic

disaccharide (ND-BSA) residue of phenolic glycolipid I

of M. leprae, whereas the other titrates primarily IgG

antibodies against sonicate supernatant antigens of

Mycobacterium w. (M.w.). Fifty coded leprosy sera

were analysed by ElAs under a double blind code.

Amongst the 20 LL patients with positive nasal smear,

18 (90%) were positive in EIA based on ND-BSA, in

comparison to 19 (95%) in EIA using M.w. antigens.

The assays can be performed on fresh serum samples

or on blood samples collected on filter paper discs.

These assays can be useful for leprosy control

programmes.

MOUDGIL, K. D.; GUPTA, S. K. & TALWAR, G. P.

Generation and characterization of a human

monoclonal antibody against phenolic glycolipid-I

of M. leprae. Indian J. Leprosy, 61(4): 479-

484, 1989.

ABSTRACT - The development of an Epstein-Barr

virus transformed human B-cell line secreting a

monoclonal antibody (MoAb), KR2/B5 is described.

KR2/B5 is an IgM type antibody and is highly specific

for phenolic glycolipid-I (PGL-I) a component unique

to M. leprae. The MoAb appears

Hansen. Int. 14(2):158-169, 1989.

to be directed against the terminal sugar

residue of the immunodominant trisaccharide

component of PGL-1.

MULLINS, R.J. & BASTEN, A. Effect of Preincubation

on the Proliferative Response to Antigen by Cells

from Leprosy Patients and Healthy Controls.

Int. J. Leprosy, 57(4):777-787, 1989.

SUMMARY - One of the postulated mechanisms

contributing to the selective T-cell hyporesponsiveness

in patienst with leprosy is receptor blockade, the

characteristic feature of which is reversibility following

preicunbation of cells in vitro. To test this hypothesis,

peripheral blood mononuclear cells (PB MC) obtained

from 17 leprosy patients and 10 healthy Mantoux-

positive and -negative controls were cultured freshly

or after a period of preincubation in serum-containing

medium, and the proliferative responses to

Mycobacterium leprae, BCG, and streptokinase-

streptodornase (SKS D) were measured. On the basis

of the response to M. leprae, the leprosy patients

could be divided into low, intermediate and high

responders. Preincubation for 2-16 hr resulted in

enhanced proliferation by cells from moderate

responders, but not from low or high responders.

Although the effect was serum dependent, it was

neither antigen specific nor was it confined to cells

from leprosy patients. Thus, an increase in response

to both the crossreactive and unrelated antigens BCG

and SKSD occured, and the same trend was observed

when cells from healthy controls were preincubated in

serum-containing medium. Furthermore, cells from

different individuals displayed varying responses to

different antigens following preincubation, suggesting

that the effect of this step was neither confined to

isolated individuals nor to particular antigens. The

addition of pronase to the preicubation step did not

further enhance the response to antigen over and

above that obtained with preincubation alone. It was

therefore concluded that the enhanced proliferative

response to antigen following preincubation was an in

vitro phenomenon dependent upon, the culture

conditions employed, was not specific to leprosy, and

was not related to receptor blockade.

MUSTAFA, A. S. Identification of T.cell-activating Recombinant Antigens Shared

Among Three Candidate Antileprosy Vaccines,

Killed M. leprae, M. bovis, BCG, and

Mycobacterium w. Int. J. Leprosy, 56(2):265-

273, 1988.

SUMMARY - Antigenic crossreactivity among

three candidate antileprosy vaccines, killed

Mycobacterium leprae, BCG, and Mycobacterium W,

was studied using T-cell lines and clones raised from

BCG- and killed- M. leprae-vaccinated subjects. To

identify the crossreactive antigens, the T-cell lines and

clones were tested against Escherichia soli lysates

containing 65-, 36-, 28-, 18-, and 14 kilodalton (kDa)

and 1393 M. leprae antigens and 65-, 19-, and 12-kDa

M. tuberculosis antigens. The short-term T-cell lines,

which compared to T-cell clone sare easy to raise and

maintain, were equally effective in identifying the T-

cell-activating recombinant antigens. The reactivity

pattern of the T-cell lines and the clone suggest that

65-kDa M. leprae and M. tuberculosis antigens are

present in M. leprae, BCG, and Mycobacterium w 18-

kDa M. leprae antigen is shared between M. leprae

and Mycobacterium w, 1383 M. leprae antigen is

possessed by M. leprae and BCG. These and other

unidentified T-cell-activating antigens shared among

candidate leprosy vaccines may be the basis for

induction of in vivo sensitization to M. leprae antigens

after vaccination with BCG or Mycobacterium w.

MUSTAFA, A. S. & QVIGSTAD,

E. H LA-DR-restricted Antigen-induced

Proliferation and Cytotoxicity Mediated by CDA+

T-cell Clones from Subjects Vaccinated with Killed

M. leprae. Int. J. Leprosy, 57(1):1-11, 1989.

SUMMARY - Thirteen CD4 + T-cell clones raised

against Mycobacterium leprae from three M.

leprae•vaccinated subjects were studied for major

histocompatibility complex (MHC) restriction in

proliferative and cytotoxicity assays. These T-cell

clones recognizes at least nine different epitopes,

ranging from M. leprae-specific to broadly

crossreactive. Restriction studyes with a panel

antigen-presenting cells (ARCS) suggest that all of the

T-cell clones recognized antigens in the context of the

DR locus. Three T-cell clones with three different

reactivities from a DR1, 2-positive subject

Hansen. Int. 14(2): 158-169, 1989.

164
responded to M. leprae in proliferation and cytotoxicity

when the antigen was presented in the context of

DR1-positive APCs. Four T-cell clone responding to M.

leprae-specific or crossreactive epitopes from the

second donor, who was DR4,DW4, DR4, Dw 14-

positive, and a single M. leprae-specific T-cell clone

from the third subject, who was DR3,4:Dw4,

recognized the antigens in the presence of Dw4 APCs.

Four crossreactive T-cell clones from the second

subject responded in the presence of Dw 14-positive

APCs, and one limited crossreactive clone recognized

the antigen in the context of DR4 and DR7-positive

cells, suggesting that its response was restricted by a

common determinant. The T-cell clones that recognize

the 65-kDa, 18-kDa, and 1383 recombinant M. leprae

antigens in proliferative assays were cytoxic for

autologous adherent cells pulsed with the respective

antigens. The response of the respective T-cell clone

to the recombinant antigens in proliferating and

cytotoxicity was restricted by similar class li molecules

as for killed M. leprae, i.e., the 65-kDa antigen was

recognized in the context of DR1, the 18-kDa antigen

in the context of DR4, Dw4, and the 1383 antigen in

the context of DR4 and DR7 class II MHC molecules.

The experiments with Dw4 and Dw14-positive mixed

adherent cells and appropriate T-cell clones suggest

that cytotoxicity requires direct interaction between

CD4 + T cells and antigen-presenting cells.

MUTIS, T.; SHOOTEN, C.A. Van & VRIES, R. R. P. de A

Peptidoglycan protein Complex Purified from M.

leprae Cell Walls Constains Most or All

Immunodominant M. leprae T-Cell Antigens. Int.

J. Leprosy, 57(4):788-793, 1989.

SUMMARY - The outcome of an infection with

Mycobacterium leprae is correlated with the T-cell-

mediated immune response developed against this

pathogenic agent. The identification of M. leprae

antigens that are recognized by T cells is therefore of

great importance. In this paper we present the results

of in vitro lymphoproliferation assays in which T-cell

reactivity was measured against a peptidoglycan-

protein compelx (PPC) which was purified from the cell

wall of M. leprae. Twelve M. leprae-reactive T-cell

clones with different antigen specificities from a

tuberculoid (TT) leprosy patient showed proliferative

responses, but only when PPC was presented by HLA-

DR-matched antigen-presenting cells (APCs). Four of

these


clones were known to react with the recombinant

mycobacterial 65-kDa protein. A tetanus-toxoid-

reactive T-cell line from a healthy control was not

stimulated by this complex, supporting the idea that

the stimulation by PPC was antigen specific Both

PPD-reactive and M. leprae-reactive T-call lines from

healthy individuals were stimulated by PPC. However,

when this complex was presented to PPD-reactive T-

cell lines derived from two lepromatous (LL) leprosy

patients, we did not observe any proliferative

responses. From these results we conclude that PPC

contains most or all of the antigens which stimulate

M. leprae-reactive T cells in association with relevant

HLA class II molecules, including the 65-kDa protein

or at least some immunogenic parts of it.

PETCHCLAI, B. at al. A Passive Hemagglutination Test

for Leprosy Using a Synthetic Disaccharide

antigen. Int. J. Leprosy, 56(2):255-257, 1988.

SUMMARY - There is a need for a simple,

sensitive, and specific test for the serodiagnosis of

leprosy. A passive hemagglutination (PHA) test for

leprosy was developed to meet these requirements. A

synthetic disaccharide, conjugated to bovine serum

albumin and specific for the phenolic glycolipid of

Mycobacterium leprae, was sensitized to aldehyde

preserved and tanned sheep erythrocytes (SRBC).

The sensitized SRBC were used for testing sera from

leprosy and tuberculosis cases and normal controls at

1: 64 and 1:128 serum dilutions. It was found that if

the hemagglutination reaction at - 1:128 is

considered positive, the test was positive in 84.2% of

38 cases of multibacillary leprosy, 16.7% of 24 cases

of paucibacillary leprosy, 16.7% of 6 contacts of

multibacillary leprosy, 11.8% of 51 cases of

tuberculosis, and 3.7% of 54 blood donors. If the

cutoff value used was 1:64, the test was more

sensitive but less specific. The results are similar to

that of an EUSA for IgM antibody to the same

synthetic antigen. The present PHA test is simple and

sensitive, but moderately specific. Its simplicity and

sensitivity make it highly suitable for large-scale

screening of contacts in leprosy-endemic areas.

RAMOS, Tereza at al. T-Helper Cell

Subpopulations and the Immune Spectrum of

Leprosy. /Editorials/ Int. J. Leprosy, 57(1):73-

81, 1989.

RANA, N. S.; GUPTA, H. P. & SINGH, N. B. Use of non

conventional antigen: M. Haban in detecting M.

leprae antibodies from leprosy patients and

contact in Fla-ABS test. Indian J. Leprosy,

60(4): 593-599, 1988.

ABSTRACT - An indirect immunofluorescent (FLA-

ABS) test has been developed to detect M. Leprae

specific antibodies in the active and subclinical cases

of leprosy. An antigenically related mycobacteium, M.

habana, was used as an antigen to detect M. leprae

specific antibodies in the sera sample of leprosy

patients. A comparison was made with M. leprae

antigen using same set of sera samples. M. habana is

capable of detecting anti-M. leprae antibodies in the

serum samples of leprosy patients, previously

absorbed with various mycobacterial antigens,

cardiolipin and lecithin, almost to the same percentage

as M. leprae. Possible use of M. habana antigen as an

alternative to M. leprae, in the serodiagnosis of

leprosy, has been discussed.

SAIDI, K. G. at al. Vaccination and Skin Test Studies

on Children Living in Villages with Differing

Endemicity for Leprosy and Tuberculosis. Int J.

Leprosy, 57(1): 45-53, 1989.

SUMMARY - The purpose of this study carried out

in Iranian Azerbaijan was to determine the pattern of

skin-test positivity to mycobacterial antigens in

children living in the valley, and to assess the effect on

this of a series of vaccines against mycobacterial

disease. Set up in 1978, 1707 tuberculin-negative

children without scars of previous BCG vaccination

were vaccinated with BCG Glaxo alone (vaccine A) or

with the addition of a suspension of killed

Mycobacterium vaccae (vaccine B). One hundred

children were vaccinated with BCG Glaxo plus a

suspension of M. leprae (vaccine C). Eight to 10 years

later about half of the children were found for follow

up. At this time further children were skin tested, and

the results obtained were related to whether or not

they had scars of

Hansen. Int. 14(2): 158-169, 1989.

vaccination with BCG Pasteur (Teheran) given by the

local health authorities.

Between setting up the study and the first follow

up, cases of leprosy or tuberculosis had occurred in

some of the villages, although not among those we

had vaccinated. Differences between the effects of the

vaccines were only found in villages with cases of

leprosy. In these villages positivity to leprosin A was

significantly greater after vaccine B (49%) than after

vaccine A (36%; p - 0.04). The results for scrofulin

and vaccin were the same after both vaccines, and

significantly lower than in the villages without cases of

leprosy. The general reduction in skin-test positivity in

the villages with leprosy cases was mainly due to a

loss of category 1 responder to group i, common

mycobacterial, antigens.

It was concluded that where casual contact with

cases of leprosy occurs the combination of BCG with

killed M. veccae is likely to be a better vaccine for

leprosy than is BCG alone. Although few children

received the combination with M. leprae, the results

obtained were not particularly promising.

SAMPATAVANICH, S. at al. Immunoepidemiglogical

Studies on Subclinical Infection Among Leprosy

Household Contacts in Thailand. Int. J. Leprosy,

57(4):752-765, 1989.

SUMMARY - Three-thousand-fourteen leprosy

house-hold contacts in Thailand were surveyed by

their personal history, physical examination, and

immunological tests. The results were compared with

those obtained from villagers in leprosy-endemic and

nonendemic areas. The percentages of young people,

students, children and grandchildren of the patient,

the contacts of multibacillary leprosy cases, long

duration of contact, BCG vaccination, FLA-ABS and

Dharmendra's lerpom in-positive responders were

significantly higher in the household contacts than

those in the villagers. The percentages of neural and

dermal symptoms were not significantly different

between the household contacts and the villagers in

the endemic area, but the percentages were higher

than those of the villagers in the nonendemic area. A

PPD skin test was more frequently negative In the

former two groups than In the letter. Both FLA-ABS

and lepromin tests showed a significant correlation

with the age of the contacts, their occupations, blood

relation to the

Hansen. Int. 14(2):168-189, 1989.

166
patient, the duration of contact, BCG vaccination,

dermal signs such as an ill-defined plaque or macule

with or without sensory loss, but did not correlate with

sex, type of leprosy in the patient, or other skin

diseases. The FLA-ABS test in the household contacts

and the villagers in an endemic area showed a

significant correlation with the neural signs, such as

enlargement of the peripheral nerve without sensory

loss.These suspicious dermal and neural signs and

symptoms were therefore considered signs of

Mycobacterium leprae infection. The FLA-ABS test was

sufficiently sensitive for detecting this infection and did

notcermiate with the lepromin or PD skin tests.

FLA.ABS-positive but lepromin-negative responders

were found In 33.5% of the household contacts. They

were considered to be a high-risk group who may

develop clinical leprosy. Nearly half of them were

treated with dapsone or BCG according to the results

of the PPD skin test. Follow up of these contacts,

together with the remaining contacts without

treatment, is in progress.

SENGUPTA, U. at al. Soluble antigen of M. leprae

coupled with liposomes elicits both "early" and

"late" delayed hypersensitivity skin reactions.

Int. J. Leprosy, 56(1):45-49, 1988.

SUMMARY - The soluble antigen(s) of

Mycobacterium leprae was (were) coupled to

Iiposomes and used for skin testing of leprosy

patients, hoping that this mode of antigen

presentation would be identical to that of integral

lepromin. The liposomized antigen(s) elicited both

early (24-48 hr) and late (3-4 weeks) delayed-type

hypersensitivity reactions, true to the nature of

lepromin, unlike the soluble antigen(s) alone which

elidt(s) only the early reaction.

SHIVRAJ, L. et al. Antibodies to HIV-1 in Sera from

Patients with Mycobacterial Infections. Int. J.

Leprosy, 58(4):548-561, 1988.

SUMMARY - Sera from 478 persons (348 leprosy

patients, 33 tuberculosis patients, 29 healthy contacts

of leprosy patients, 38 normal heaity Indians, and 30

normal .healthy Europeans) were screened for anti-

HIV-1 IgG antibodies by ELISA. None was positive. In

addition, 132 samples (from

Hansenlase: Resumos/Hansenfasis Abstracts - IMUNOLOGIA 167

43 leprosy patients, 21 tuberculosis patients, 5

healthy contacts of leprosy patients, 33 normal

healthy Indians, and 30 normal healthy Europeans)

were also tested by Western blot assay for anti-HIV-1

IgG antibodies. Only I of the 63 healthy subjects

expressed a prominent p 17 band. One or more

bands were found in 44 (leprosy patients 33/43,

tuberculosis patients 7/21, and leprosy contacts 4/5)

of the remaining 69 sera. Antibody to the HIV-1-

specific antigen p24 was expressed by 17 of these

subjects (14/43 leprosy patients, 1/21 tuberculosis

patients, and 2/5 leprosy contacts), either as a single

band or in combination with other bands. This raises

the possibility of a common antigenic pattern

between HIV-1 and mycobacteria, especially

Mycobacterium leprae.

SINGH, N. B. & CHOUDHARY, A. Detection of leprosy

antigenuria through DOT-EUSA. Indian J.

Leprosy, 60(4): 526-529, 1988.

ABSTRACT - Fifty-five samples of urine from

different grades of leprosy patients and normal

persons were processed for detection of PGL-1

antigen through DOT-ELISA on nitrocellulose paper

strips using anti-human IgG horse raddish

peroxidaseconjugate. About 66.6% of the

paucibacillary and 100% of the multibacillary leprosy

cases were detectable through this technique on the

basis of differential colour development on the strips.

Possibility of its use in the field conditions has been

discussed.

SIRINIVASAN, R. & RAO, P. R. Humoral immune

responses in dapsone treated M. tepee infected mice.

Indian J. Leprosy, 61(2)151-159, 1989.

SUMMARY - Humoral responses in M. leprae

infected mice were studied through 52 weeks and

were found to be directly related to the bacterial

load. However, treatment with dapsone (DDS) in the

last 12 weeks of infection resulted in an initial

enhancement of the humoral responses followed by a

gradual decrease, though they were still significantly

high at the end of the study.

STANFORD, J. L at aI. Vaccination and Skin Test

Studies on the Children of Leprosy Patients. Int.

J. Leprosy, 57(1):38-44, 1989.

SUMMARY - In an attempt to achieve maximal

skintest positivy to leprosin A in children of leprosy

patients living in Baba Baghi Leprosy Sanatorium in

Iranian Azerbaijan, two new vaccines have been

employed. Children without scars of previous BCG

and without response to leprosin A were given a

vaccine containing 108 viable units of BCG Glaxo plus

107 killed Mycobacterium vaccae per dose (vaccine

B). Children with BCG Pasteur (Teheran) scars but

without response to leprosin A were given a vaccine

containing 108 killed M. vaccae alone (vaccine D).

Eight years later skin testing was repeated, and both

new vaccines were found to have significantly

increased the numbers of children responding to

leprosin A above the level that would have been

expected had they received BCG Pasteur alone. This

increase was due in large part to incrases in the

proportions of individuals responding to group i

(common mycobacterial) antigens, and known as

category 1 responders. The use of suspensions of

killed M. vaccae in conjunction with BCG may

represent a considerable advance in inducing

protection from muitlbacillary leprosy in close

contacts of leprosy patients if leprosin A positivity is

truly a correlate of protective immunity. A

comparison, using the same criteria, with the other

proposed vaccines for leprosy would be very

interesting.

VADIEE, A. R. et al. Armadillo IgG and IgM

Antibody Responses to Phenolic Glycolipid-I During

Experimental Infection with M. leprae. Int. J.

Leprosy, 56(3):422-427, 1988.

SUMMARY - The kinetics of antibody rsponses of

Mycobacterium leprae-infected armadillos to phenolic

glycolipid-I (PGL-I) were studied by means of ELISA.

The levels of both IgG and IgM antibodies to PGL-I

increased with time. Some animals were less

susceptible to disseminations of M. leprae Infection

and lived longer than others. These animals had high

absorbance values (- 0.7) for IgG anti-PGL-1

compared to more susceptible armadillos that had

lower absorbance values for IgG anti-PGL-1.

VADDIE, A. R. et al. Partial Characterization of

Antigens from M. leprae Evoking IgG and

Antibodies in Armadillos. Int. J. Leprosy,

56(2):274-282, 1988.

SUMMARY - Armadillo IgG and IgM antibody

responses to Mycobacterium lapse were analyzed

using isotypic-specific antisera by means of

Immunoblotting. Blots developed for IgG antibodies

to M. leprae showed multiple protein antigens (Mr =

12-90 K) in some heavily infected armadillos. In

contrast, blots developed for IgM antibodies to M.

leprae showed a single, broad, diffuse band of

immunoreactivity at approximately 33 kDa. The 33-

kDa immunogen was detectable with silver stain

modified for carbohydrate reactivity, suggesting the

presence of a polysaccharide component. In addition,

binding of 125 1-concanavalin A to the 33-kDa

component demonstrated the presence of mannose

and/or glucose residues.

VAISHNAVI, C. at al. Effect of in vitro formed immune

complexes on macrophage functions fo

Mycobacterium lapse Infected mice. Indian J.

Leprosy, 60(2):242-251, 1988.

ABSTRACT - Nonspecific macrophage functions

were studied in Mycobacterium leprae infected and

preformed immune complex (IC) administered normal

(NI) and thymectomised/irradiated (TRI) mice at

different time periods. Uninfected controls given IC

were also included. Significant decrease in the

chemotaxis, phagocytosis and bactericidal activities of

macrophages obtained from infected groups

compared to their controls were observed. Phagocytic

and chemotactic activities of macrophages were

normal but Intracellular killing was seen to be

depressed In studies conducted in normal and

thymectomised immuno suppressed groups

(Vaishnavi at al., 1985), (Kumar et al, 1987) which

were not administred with preformed IC.

VAISHNAVI, C. at ai. Effect of suppressor cells

on antibody producing cells in mice infected with M.

leprae. Indian J. Leprosy, 81(1):72-78, 1989.

ABSTRACT: Swiss albino mice were transfused

with suppressor cells obtained after In vivo

stimulation of mice with Con A (NS group). Some of

the animals were infected with Mycobacterium leprae

(NSI-group). Half of these animals were treated with

dapsone (NSIT group). Adequate normal (NC) and

infected (NI) controls

168

Hansen Int. 14(2): 158-169, 1989


were Included. A plaque assay was carried out at

different time periods to elucidate the effect of

suppressor cells on antibody producing cells. No

significant difference was seen in the number of

plaque forming cells (PFC) in infected and dapsone

treated animals (NSIT) when these were compared

with controls. However significant increase seen in the

number of IgM plaque forming cells at 5 months in NI

and NSI groups and IgG PFC in NI group could be due

to the peak footpad infection durign this period. The

significant decrease In the number of IgG PFC in NS

and NSIT group compared to NC at 0 month Is

probably due to the suprressor cell activity in these

groups.

WALTER, J. The post-lepromin scar and its significance

in the control of HD. Indian J. Leprosy,

61(3):379-386, 1989.

SUMMARY - In the past little attention has been

paid to the post-lepromin scar (PLS) and Its use in

controlling Hansen's disease (HD), particularly in the

prognosis, classification and measurement of CMI

response. The immuno-information of the 1Mitsuda

reaction is thought to be informative only in the

extreme range of 10 + mm or in its absence. Previous

studies have shown that the range of PLS formation

increases proportionally to the degree of lepromin

positivity. PLS positive HD patients have a stable form

of the disease with good prognosis. Those unable to

form a PLS have a marked tendency to downgrade

towards the lepromatous form of HD. PLS formation

appears to indicate a CMI response to M. leprae

implying immunity. It is thought that there exists a

correlation between the PLS and the lymphocyte

transformation test (LTT), both reaching their

optimum mesurement three months after the M.

leprae injection, either with lepromin or M. leprae

suspension used for the anti-HD vaccine. It is

proposed to study the use of the PLS in HD control

programs on a trial basis with the objective of its

general introduction as part of the management of HD

control. Considerable improvements in the prognosis,

classification and applcation of treatment can be

expected from such a measure. The discovery of the

armadilo as a source of M. leprae by Kirchheimer and

Storrs facilitates the availability of lepromin A and its

purified version, lepromin Ap. The relevant studies

have shown that a 40 M/bact/ml lepromin A

suspension should be used for the application of

lepromin in control programs.

H


It is concluded that the routine reading of the PLS,

particularly under field conditions where alternative

tests are difficult to perform, will be of considerable

benefit for the HD patient.

WATSON, J. D. Prospects for New Generation Vaccines

for Leprosy: Progress, Barriers, and Future Strategies.

/Editorials/. Int. J. Leprosy, 57(4):834-843, 1989.

YANDAVA, C. N. et al. Lymphoproliferation and in Vitro

Antibody Synthesis in Leprosy Patients. Int. J.

Leprosy, 57(3):633-640, 1989.

SUMMARY - An in vitro system to assess B-cell

funcion in leprosy patients is described. In vitro

lymphoproliferation and antibody synthesis by

peripheral blood mononuclear cells (PBMC) in

response to pokeweed mitogen (PWM) and Formalin-

treated Staphylococcus aureus Cowan I (FSA) from 31

leprosy patients and 13 healthy controls were studied.

DNA synthesis was induced by both PWM and FSA in

PMBC from all of the leprosy patients and control

subjects. Lepromatous

leprosy ILL) patients' cells showed higher responses

to both PWM and FSA. However, these Increases were

not statistically significant. The levels of secreted IgM,

IgG, or Ig were examined in the 7-day culture

supernatans of PBMC cultured with or without PWM or

FSA using an enzyme linked immunosorbent assay.

Wide individual variations were observed in in vitro

antibody synthesis. IgM secretion in PBMC from

normal subjects and various groups of leprosy patients

in response to PWM and FSA was comparable. In vitro

IgG secretion in response to PWM was the highest in

cells from LL patients; it was significantly decreased in

cels from tuberculoid leprosy (TT) patients (p: 0.01).

The levels in cells from borderline leprosy (BB)

patients were intermediate in response to the same

mitogen. Cells from leprosy patients as a group

showed a higher spontaneous secretion of IgA in

comparison with cells from normal subjects. Overall,

the in vitro Ig secretion by PBMC in different patient

groups appears to reproduce the spectrum of antibody

levels observed in patients in vivo. Thus, the preesnt

in vitro culture system may help to delineate the

mechanisms of B-cell dysregulation In leprosy.

ansen. Int. 14(2):158-189, 1989.

ABDULKADIR, S. Bacteriology of Infected hands and

feet leprosy patients. Indian J. Leprosy,

61(1):65-67, 1989.

ABSTRACT - 70 cases of infected hands and feet

admitted to ALLERT Hospital during 1986/1987

(3/10/86 - 5/5/87) were studied for the infecting

organisms and the sensitivity of these organisms to

available antibiotics. Single organisms were isolated

in 56 cases (95%), two organisms were isolated in 3

cases (5%), no organisms were isolated in 11 cases

(15,7%). Proteus was the commonest organism.

Most effective drug was Ampicillin. Three organisms

isolated in 7 cases proved resistant to all drugs

tested. The study shows that commonly available

drugs are effective in the great majority of secondary

infections in leprosy patients.

ABEL, L. et al. Genetic Susceptibility to Leprosy

on a Caribbean Island: Linkage Analysis with Five

Markers. Int. J. Leprosy, 57(21:465-471, 1989.

SUMMARY - Our recent segregation analysis,

carried out on 27 large pedigrees from a Caribbean

island (Desiradel, has shown the presence of

recessive major gene(s) controlling susceptibility to

leprosy per se and nonlepromatous leprosy,

respectively. Linkage analysis was performed

between each of these two detected genes and each

of five markers typed in the Desfrade population:

HLA, ABO, Rhesus, Gm and Km. No positive

significant lod score was observed. However, for

leprosy per se close linkage was excluded with

Rhesus and Gm (and also with ABO and HLA,

considering a lower value for the frequency of the

gene controlling susceptibility to leprosy per se). The

highest lod score, although not significant, was

obtained between the gene for nonlepromatous

leprosy and ABO. Our overall results, joined with

previous studies and experimental data, suggest that

the gene controlling susceptibility to leprosy per se

and that controlling susceptibility to nonlepromatous

leprosy might be different, acting at successive

stages of the immune response to infection with

Mycobacteriumleprae.

BHATHIA, V. N. Filamentous phase in life (7): a

preliminary communication. Indian J. Leprosy,

60(3):422-426, 1988.

ABSTRACT - Certain structures which indicate

p

c

b

T

s

m

w

B

c

s

b

m

i

m

B

r

s

u

a

i

B

M

w

l

s

T

T

o

s

170

Hansen. Int. 14(2): 170-180, 1989


robable involvement of a filamentous phase in life

ycle of M. leprae have been noted in preserved skin

iopsy suspensions from lepromatous leprosy cases.

hese include (i) filaments with empty or pink round

paces within them (ii) conidia-like structures and (fill

embranes with acid fast bacilli. These structures

ere rare in the fresh material.

ATHIA, V. N.; CHERIAN, E. & HARIKRISHNAN, S.

Auramine staining in detecting small number of

bacilli in skin smears. Indian J. Leprosy,

60(1):13-16, 1988.

ABSTRACT - Auramine staining has been

ompared with Ziehl-Neelsen's staining of M. leprae in

kin smear slide. The auramine method was found to

e more sensitive than Zlehl-Neelsen's method and

ay be useful in detecting small number of M. leprae

n skin smears. The inter-observer variance was

inimal with auramine staining.

HATIA, V. N. Bacteriological study of urine samples

from leprosy patients: a preliminary

communication. Indian J. Leprosy, 61(2): 472-

475, 1989.

ABSTRACT - A.F.B. and biological structures

elated to its multiplication reported previously from

kin and blood of patients were seen also in their

rine. Implications of these findings In transmission

nd possible application in detecting sub-clinical

nfections should be studied.

ATHIA, V. N. & RAO, S. Morphology of M. Leprae in

VS3 medium-A preliminaty

communication. Indian J. Leprosy,

61(2):160-163, 1989.

ABSTRACT - In a previous attempted culture of

. leprae in VS2M medium non-acid fast organisms

ere seen initially and acid fast organisms appeared

ater. A drop of a sonlcated suspension from a

ubculture of this was Inoculated in VS3E medium.

he inoculum consisted mostly of acid fast granules.

he culture yielded pure growth of acid fast

rganisms. Morphology typical of M. leprae could be

een only after 60th day of culture.

Hanseníase: Resumos/Hanseníasis Abstracts - MICROBIOLOGIA 171

BERA, A. & BANERJEE, A. Studies on lipids in

mycobacterial cell wall: their importance structure

and function relating to pathogenecity and their

biological activity. Indian J. Leprosy, 61(2):

143-150 1989.

ABSTRACT - The lipids cord-factor, mycosides

and suipholipids are supposed to be vitally linked with

the pathogenecity of mycobacterla. In this paper an

attempt has been made to clarify the understanding of

the occurrence, organisation and possible interaction

of the diverse lipids present in the mycobacterial cell

wall and their possible structure and function.

CHATTERJEE, B. R. & ROY, Roma Das. Growth of

Mycobacterium leprae in a redox system: III evidence

of growth at low temperature (Psychrophilia) and,

further refinement of growth medium. Indian J.

Leprosy, 61(4):458-466, 1989.

ABSTRACT - Considerable growth enhancement,

largely as non-acid fast, slender and long rods has

been seen when incubated at 109C. Concentration of

some of the media constituents have been reduce that

has improved the quantum of growth. A remarkable

proneness to physical disintegration of the grown

bacilli has been seen and its signficance discussed.

Also, the possible immunogenic advantage of non-AF

M. leprae has been discussed. The question of

identification is still not solved, and work is in

progress.

COLOGLU, A. A. Process of deintegrat)on and

degradation of M. leprae: study of tissue imprints

and tissues. Indian J. Leprosy, 61(4):485-494,

1989.

ABSTRACT - The existence, distribution and

behaviour of degradation products of M. leprae In

leprosy lesions were investigated in tissue specimens

fixed in neutral formalin and embedded in parafin.

Cytopathologic findings using tissue imprints were

unsatisfactory. Sections were stained

Hansen. Int. 14(2):170-180, 1999.

with hematoxylin-eosin, acid-fast stains, silver

methenamine and by an immunochemical (PAP)

technique using serial paraffin sections. A comparison

in respect of the distribution of the bacilli within the

macrophages showed considerable differences

between the superficial and deep granulomas. This

corresponds roughly with the central, intermediary and

peripheral locations. In a small granuloma seen in BL

lesions, there were two zones: central and peripheral.

In a large LL granuloma, three zones were seen,

central, intermediary and peripheral zones. It is

suggested that the degradation of disintegrated

particles of bacilli might be due to the lysozymal

activity of macrophages. The phagocytized bacilli are

slowly degraded with long incubation periods, but the

undigested debris remain inside the phagosomes. The

chemical complexity of cytoplasm, cell wall and lipid

fractions of M. leprae, and it is such that the lipid

fractions of M. leprae mask some other antigenic

components, which may be responsible for the cellular

response and lysozymal production. According to our

findings we believe that chemotherapy kills M. leprae

but degraded products are not removed. These

components are chemically complex and digested with

difficulty. Lysozymal enzymes could be Inhibited from

productions by the bacterial debris or the lipid

fractions could serve as a mask to delay lysozymal

production in the cell. These aspects need further

study.

COLSTON, M. J. & LAMB, F. I. Molecular biology of

the mycobacteria. /Editorial/. Leprosy Rev. 60(2):89-

93, 1989.

ABSTRACT - The molecular biology of the

mycobacteria is poised at the threshold of making

major contributions to the understanding of the

biochemistry and pathogenic mechanisms involved in

mycobacterial infections. The application of molecular

biology to the study of mycobacteria has recently

begun, with preliminary studies on the nucleic acids of

mycobacteria, cloning and expression of a number of

mycobacterial genes and the development of

mycobacterla themselves as gene cloning systems. In

this review, we wil discuss the progress that has been

made so far and the likely direction of future work.


CREE, I. A. at al. The influence of antimycobacterlal

chemotherapy on delayed hypersensitivity skin-

test reactions in leprosy patients. Leprosy

Rev., 59:145-151, 1988.

SUMMARY - Skin tests using purified proteins

derivative (PPD) and Rees' skin test antigen (RSTA),

a soluble extract of Mycobacterium leprae, were

performed in 53 treated leprosy patients, 52 newly

diagnosed untreated leprosy patients and 78

household contacts of untreated leprosy patients in

northern Bangladesh. In addition, a small group of 20

leprosy hospital workers and a further group of 50

indigenous subjects with no known exposure to

leprosy were studied.

Untreated paucibacillary and multibacillary

patients showed significantly fewer positive reactions

than comparable groups of treated patients to both

PPD and RSTA. It appears from these results that

treatment of leprosy patients is associated with

enhanced ability to produce a delayed-type

hypersensitivity response to mycobacterial antigens.

The mechanisms underlying this phenomenon may

include both general and specific suppression of

antimycobacterial delayed-type hypersensitivity. The

household contacts and indigenous subjects showed

similar skin test responsiveness, but virtually all of

the hospital workers responded to both PPD and

RSTA. The implications of these results for studies of

immunity in leprosy patients are discussed.

DHANDAYUTHAPANI, S.; NAUNI, N. & BHATIA, V. N,

LDH isoenzyme as a tool for the identification of

mycobacteria. Indian J. Leprosy. 61(1):61-64,

1989.

ABSTRACT - Using Polyacrylamide gel

electrophoretic technique, the lactate dehydrogenase

(LDH) isoenzyme patterns have been studied in four

slow growing mycobacteria viz. Mycobacterium

tuberculosis, M. avium, ill mlcro6, andM. bolls and

four rapid growing mycobacteria viz. M. fortultum,

P4. paraforlultum, M. themwresisfible and M.

dlemhoferL Each mycobacterial species exhibited

distinct isoenzyme pattern for LDH.

FOSTER, R. L. et al. Effect of diet on growth of M.

leprae in mouse footpads. Indian J. Leprosy,

61(1):360-366, 1989.

ABSTRACT - Semipurified diets, with equal

amounts of vitamins, minerals and fibre, but varied in

protein and fat content from pork, barbel fish or soya

beans were tested for their possible effect on the

growth of M. leprae in mouse footpads. 105 BALB/c

male weanling mice were randomly divided into five

diet groups of 21 mice each and fed for six months.

Differences between bacterial counts of diet groups

were found. The mouse foot pad model is suitable for

dietary study in leprosy.

GELBER, R. H. et al. Serum Antibodies to Defined

Carbohydrate Antigens During the Course of

Treated Leprosy. Int. J. Leprosy, 57(4):744-

751, 1989.

SUMMARY - Sequential monitoring of 724 sera for

antibodies to a neoantigen based on phenolic

glycolipid-I (PGL-I) and native lipoarabinomannan

(LAM) in 90 leprosy patients undergoing therapy in

San Francisco was conducted. Untreated lepromatous

patients frequently (91%) had significant antibodies to

both moieties. Antibodies were less frequently found in

tuberculoid patients (74% to neoantigen and 37% to

LAM). In the first 3 years of treatment, average serum

antibodies to both moieties fell significantly. Antibodies

to LAM fell during each of the first 4 years of therapy,

but decreasing antibody levels to the PGL-I neoantigen

did not appear to fall consistently after the third year

of treatment. A wide variation in the rate of fall of

serum antibodies was noted. Sequential changes in

the amounts of serum antibodies to the neoantigen

and LAM in general paralleled one another but were at

times discrepant. Both in San Francisco and Malaysia,

skin-smear negative, long-term treated, lepromatous

leprosy patients frequently harbored significant

antibodies to both PGL-I and LAM.

GEORGE, J.; BATHIA, V. N. & BALAKRISHNAN,

S. Microbiological assay versus spectrophotomotry for

determination of rifampicin in urine. Indian J.

Leprosy. 60(1):47-52, 1988.

ABSTRACT - A comparative study on the

microbiological and spectrophotometric methods for

estimation of rifampicin in urine was carried out In 15

individuals. The urinary levels of rifampicin were

determined on 2nd, 8th and 15th days at3hour

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Hanseníase: Resumos/Hanseníasis Abstracts - MICROBIOLOGIA

hour and 24 hour samples by the above methods

fter administration of 600 mg rifampicin. The results

uggest that the microbiological assay is more

ensitive than spectrophotometric method. The

ifference was highly significant in all the cases by

aired t-test. Incidentally it was also noticed that

rinary excretion of rifampicin was comparatively more

n 15th day.

ORMUS, B. J. et al. A second sooty mangabey

monkey with naturally acquired leprosy: first

reported possible monkey to monkey

transmission. Int. J. Leprosy, 56(1):61-65,

1988.

SUMMARY - The existence of naturally acquired

eprosy in a second sooty mangabey monkey has been

ocumented. The disease has the clinical and

istopathological characteristics of subpolar

epromatous leprosy (LLs), and microbiological studies

hus far confirm the etiologic agent as Mycobacterium

eprae. This mangabey had been housed in direct

ontact with the first mangabey in which naturally

cquired leprosy was diagnosed in 1979. Clinical

ymptoms appeared in the second mangabey in 1986,

lmost 7 years after the appearance of skin lesion in

he first monkey. It is likely that the second mangabey

ontracted leprosy from the first mangabey or that

oth animals contracted the disease by contact with

n unknown common third source. This is the only

nown possible natural transmission of leprosy from

onkey to monkey, and suggests that a potential

oonosis exists in wild monkeys that may serve as a

eservoir for the disease in areas where human

eprosy is endemic.

ORMUS, B. J. et al. Serologic Responses to

Mycobacterium Ieprae-specific Phenolic

Glycolipid-I Antigen in Sooty Mangabey Monkeys

with Experimental Leprosy. Int. J. Leprosy,

56(4):537-545, 1988.

SUMMARY - Four pairs of sooty mangabey

onkeys (Cercocebus atys) were inoculated with

erial, 10-fold dilutions of Mycobaderium Ieprae. The

ighest-dose pair received 4.8 x 1010 M. Ieprae.

erum samples were obtained and clinical signs of

eprosy were recorded at intervals of 35 months.

ongitudinal serum samples were assayed by an ELISA

ethod for the presence of IgG and IgM

antibodies to the M. Ieprae-speclfic phenolic

glycolipid-I (PGL-I) antigen.

In general, the onset of disease symptoms

paralleled the number of M. Ieprae inoculated, but the

ultimate course of disease depended upon individual

animal susceptibility. Both IgG and IgM anti-PGL-I

isotype were observed in variable levels and patterns,

related to the disease stage, among the eight

mangabeys.

The data suggest that high IgG and low IgM anti-

PGL levels correlated with less severe disease;

whereas initial high IgM titers and/or rising or

sustained high IgM titers, especially togethere with

low IgG anti-PGL-I titers, preceded or corresponded to

periods of progressive leprosy.

The results show that IgG and IgM anti-PGL-I

antibodies can be present in significant titers among

mangabeys early after infection with M. Ieprae. It

appears likely that the relative levels of these anti-

PGL-I isotypes may be correlated with the

susceptibility of individual animals to the development

of lepromatous leprosy.

GROSSET, J. H. of al. Activit of Ofloxacin Against

Mycobacterium Ieprae in the Mouse. Int. J.

Leprosy, 56(2):259-164, 1988.

SUMMARY - Mice Inoculated with 4800

Mycobacterium Ieprae in the left hind foot pad were

treated from day 62 to day 150 after infection with 50

mg or 150 mg of ofloxacin per kg body weight, 150

mg pefloxacin per kg, or 50 mg prothionamide per kg.

These drugs were administered by esophageal cannula

5 days weekly with dapsone (0.01 g per 100 g diet).

Multiplication of M. Ieprae in the treated and in

untreated control mice was assessed by monthly

harvests.

The treatment of mice with the smaller dosage

ofloxacin, with pefloxacin, prothionamide, or dapsone

uniformly resulted in a delay of m iltiplication of 4

months, compared to the multiplication of M. Ieprae in

the untreated controls. The delay of multiplication (4

months) being 1 month longer than the duration of

drug administration (3 months), all of the treatments

may be considered as bacterioupausal or moderately

bactericidal. In contrast with these results, treatment

of mice with 150 mg ofloxacin per kg resulted in no

growth of the organisms whatever as late as 18

months after inoculation, strongly suggesting that, in

that dosage, ofloxacin had killed all of the M.leprae.

Such a profound killing activity has been

173

Hansen. Int. 14(2):170-180,1989

observed only with rifampin. Although the

pharmacokinetic characteristics of ofloxacin are

different in man from those in the mouse, the daily

dosage of 150 mg ofloxacin per kg body weight in the

mouse is equivalent to 400 mg per day in man which

is the usual therapeutic dosage; thus, the results

obtained in the mouse may be extrapolated to man.

Therefore, ofloxacin appears a very promising drug for

the chemotherapy of leprosy.

HARADA, K. & SUZUKI, K. Improved staining of

leprosy bacilli in tissues. Leprosy Rev.,

60(2):124-128, 1989.

SUMMARY- A technique which reliably

demonstrates Mycobacterium leprae, M. tuberculosis

and fungi in tissues is described. It is based on the

oxidation of cell wall lipid substances by chromic or

periodic acid, and the subsequent release of aldehydes

which are then capable of reducing ammoniacal silver

salt solutions to metallic silver. The organisms so

demonstrated appear uniformly solid. The sensitivity

of the method and the ease of examination and

recognition of bacilli and their products are

recommendations for the use of the method in

diganosis and research, disregarding morphological

appearances.

HARRIS, E. B. et al. Inhibition of Phenolic Glyco

lipid-I Synthesis in Extracellular Mycobacterium leprae

as an Indicador of Antimicrobial Activity. Int. J.

Leprosy, 56(4):588-591, 1988.

SUMMARY - The effects of 22 antimicrobial

agents on the incorporation of [U14C] palmitic acid

([U14C]PA) into the unique phenolic glycolipid-I (PGL-

I) antigen of Mycobacterium leprae were studied.

Nude-mouse-propagated M. leprae were incubated in

a modified Dubos medium in the presence of

antimicrobial agents for 4 days. [Ú14C] PA was then

added and incubation was continued for 8 days. The

antileprosy agents dapsone, frfampin, and clofazimine

(2 mg/ml each) caused a significant reduction in

[Ú14C] PA incorporation into PGL-1. Among other

agents, the most active were eythromycin,

chloramphenicol, and cerulenin. Low concentrations of

ethionamide, tetracycline, and minocycline stimulated

label incorporation.

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his system may prove useful in the evaluation of

ntileprosy agents.

ERRERA, J. L. & ROJAS-ESPINOSA, O. Serum Lactate

Dehydrogenase in Murine Leprosy: Source and

Isozymes. Int. J. Leprosy, 57(3):641-646, 1989.

SUMMARY - The bulk of the lactate

ehydrogenase (LDH) that increases in the serum of

ice infected with Mycobaderiumlepraemurium (MLM)

erives from the liver and corresponds to the isozyme

. MLM-induced granulomas continuously arise in the

iver and steadily increase in size until the animal's

eath. Growing granulomas push the adjacent

epatocytes away and cause them to disrupt and to

elease their cytoplasmic contents, including LDH. The

DH is then picked up by the infiltrating phagocytes

nd/or admixed with the circulating blood. Other LDH-

ontaining organs (including the testis with its

dditinal isozyme LDH-X) in the infected or normal

nimals do not seem to significantly contribute to the

erum levels of LDH.

The study of the liver-associated histochemical

nd biochemical changes in this controlled model of

urine leprosy allows us to gain insight into the

verall pathology of this mycobacteriosis. In so,ne

espects this sheds light on the liver involvement in

uman leprosy; a subject on which results of all sorts

ave been published.

JAGANNATHAN, R.; PATIL, D. & MAHADEVAN, P.

R. Correlation of in vitro Fc receptor assay

with in vivo mouse foot pad method. Indian

J. Leprosy, 6114):517-525, 1988.

ABSTRACT - Resistant strains of M. leprae have

een reported to the various Antileprosy drugs. There

s currently no accepted test to identify the

usceptibility pattern of M. leprae to the drugs in a

hort period. The only accepted test is the mouse foot

ethod which takes a long period to yield results. The

c receptor assay using the ability of viable M. leprae

o alter the membrane of the macrophage is well

stablished. It takes only ten days and is inexpensive.

n 6 cases of leprosy patients the susceptibility pattern

as worked out both with the in vitro Fc receptor

ssay and the In vivo mouse foot method. The results

orrelated very well leading to the fact that the assay

ystem is

reliable. Hence it can be used not only to study the

status of a patient, but also to shortlist the number of

compounds to be teste on the mouse foot pad a s anti-

leprosy drug candidates.

JOB, C. K.; SANCHEZ, R. M. & HASTINGS, R. C.

Lepromatous ' Meningoencephalitis in the Nine-banded

Armadillo (Dasypus novemcinctus). Int. J. Leprosy,

56(2):291-295, 1988.

SUMMARY - The brains from 10 nine-banded

armadillos with lepromatous leprosy were studied

histopathologically. All of them showed evidence of

lepromatous meningitis. In two there was invasion by

Mycobacterium leprae into the brain tissue, with

neuronal cells and glial cells containing intracellular

bacilli. To our knowledge, this is the first report of

meningoencephalitis in a lepromatous nine-banded

armadillo.

JOB, C. K.; Mc CORMICK & HASTINGS, R. C.

Intracellular Parasitism of Parenchymal Cells by

Mycobacterium lepra Int. J. Leprosy,

57(3):659-669, 1989.

SUMMARY - The liver, skeletal muscle, and

adrenal gland obtained from two nine-banded armadillo

infected with Mycobacterium leprae were studied using

an electron microscope. M. leprae were found in

varying numbers inside hepatocytes. Kupifer's cells,

striated muscle cells, adrenal cortical and adrenal

medullary cells, endothelial cells, and macrophages.

There was evidence to suggest that M. leprae were

actively phagocytosed by the liver and skeletal muscle

cells. The inert nature of M. leprae and its behavior as

an almost ideal parasite of parenchymical cells are

emphasized. The question of whether this unique

parasitism of parenchymal cells and the possible

processing and presentation of M. leprae antigens by

these cells could be responsible for aberrant immune

responses is raised.

KATOCH, V. M. et aI. In vitro methods for

determination of viability of mycobacteria:

comparison of ATP content morphological index

and FDA-EB fluorescent staining in Mycobacterium

leprae. Leprosy Rev., 59:137-143, 1988.

SUMMARY - Bacilli were purified from the 23

cases of multibacillary type of leprosy. The ATP

content of these bacilli was assayed by a firefly

bioluminescent technique which is capable of detecting

a very small number of cultivable mycobacteria as

assessed by colony counts. The ATP content was

compared with morphological index (MI) and FDA-EB

staining of bacilli from the same specimens. It was

observed that when MI was 1% or more, the ATP

content/solid bacillus was fairly constant in 15 cases

studied. It ranged from 2.02 x 10-15 g to 5.60 x -15

g/solid bacillus (mean 3.46 x 10-15 g) and was in the

same range as ATP content of viable cultivable

mycobaceria. In the same 15 cases, when the green-

staining bacilli was considered as supposedly viable

bacilli, ATP content/green-staining bacillus varied up to

9-fold (0.22-15 x g to 1.98 x 10-15 g/green-staining

bacillus) and this did not correlate. The percentage of

green-staining bacilli (FDA-EB) and solid staining bacilli

(MI) was different in all the cases. In 2 cases with 0%

MI in which ATP levels were also zero, 7.5% and

21.5% green-staining bacilli were present which

implies that the enzymes responsible for green-

staining character may persist for some time after

death. The cases with 0% MI had 0% green-staining

bacilli and zero ATP levels, whereas in another 3 cases

with zero MI significantly high levels of ATP were

detected.. It is inferred that solid-staining bacilli may

be the viable bacilli but when MI is 0% (1% or less)

sampling error or clumping may be responsible for

missing out the solid bacilli in some cases. It is

concluded that the ATP content of M. leprae appears

to be an easy, rapid and sensitive tool for determining

the viability for monitoring the therapy. On the other

hand MI and FDA-EB staining appear to have their

limitations.

KAIOCH, V. M.et al. Application of ATP assay forin

vitro drug screening testing against human derived

M. leprae. Indian J. Leprosy, 61(3):333-344,

1989.

ABSTRACT - In this study, the ATP content of M.

lepme exposed to various antimicrobial agents has

been measured to evaluate its usefulness in drug

sensitivity screening. Purified M. leprae suspensions

from human biopsies have been incubated at 302C in

a modified Dubos medium in the presence of different

concentrations of various drugs viz. Rifampicin,

Ethionamide, Ethambutol,


Hansen. Int. 14(2):170-180,1989

Cycloserine, Dapsonet, Clofazimine, Erythromycin and

Tetracycline. ATP levels were estimated at 0,7 days of

incubation by the procedur..a modified and

standardised at this laboratory. ATP decay was

accelerated by ethionamide, rifampicin, clofazimine,

dapsone, erythromycin and to a lesser extent by

cycloserine, whereas ethambutol and tetracycline did

not have any significant effect. The rate of decay

depended on the concentrations of these drugs. ATP

assay promises to be a useful system for in vitro drug

sensitivity screening against M. leprae isolated from

patients.

KHANOLKAR, S. R. et aI. Identification of

Mycobacterium leprae Antigens in Tissues of Leprosy

Patients Using Monoclonal Antibodies. Int. J.

Leprosy, 57(3):652-658, 1989.

SUMMARY - Five monoclonal antibodies (MAbs)

directed against antigens of Mycobacterium leprae

were tested for their ability to bind to components of

tissue sections prepared from biopsies taken from

patients with various forms of leprosy.

Immunoperoxidase was the most successful marker

system used, although immunofluorescence and

alkaline phosphatase were also successful in certain

cases. Positivity was high all five antiboides

successfully staining those sections containing a

bacterial index of 3 + or more; sections with 0

bacterial counts also had areas staining positively with

two of the MAbs. The positive staining positively with

two of the MAbs. The positive staining in the tissues

was confined to areas infiltrated by inflammatory cells;

however it was not identifiable as being associated

with individual bacteria. These findings suggest that

immunostaining with specific monoclonal antibodies

can help to identify leprosy in diagnostic samples in

which acid-fast bacilli are not identifiable by standard

histochemical means. Immunohistochemical tecniques

are likely to be valuable in studies of the distribution fo

M. leprae antigens and their association with individual

tissue elements.

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YONS, N. F. et al. Association of IgG and IgM

antibodies to phenolic glycolipid - 1 antigen of

Mycobacterium leprae with disease parameters

in multibacillary leprosy patients. Leprosy Rev.,

59:45-52, 1988.

SUMMARY - IgG and IgM antibodies to the

henolic glycolipid-1 (PGL-1) antigen of

ycobacterium leprae were assessed using an

nzyme-linked Immunosorbent assay (ELISA) in 77

ultibacillary leprosy patients. No correlation were

ound when their absorbance values were compared

o: disease type and duration, bacillary load, reactional

tatus, or concurrent secondary infection. A statistical

ifference was seen between patients with and

ithout neurological deficiency.

MAROLIA, J. & MAHADENAN, P. R. Reactive

xygen Intermediates Inactivate Mycobaterium leprae

n the the Phagocytes from Human Peripheral Blood.

nt. J. Leprosy, 57(2):483-491, 1989.

SUMMARY - Reactive oxygen intermediates such

s hydrogen peroxide, superoxide, and hydroxyl

adicals are important microbicidal components, and

hey could also play a role in an infection with

ycobacterium loprae. A comparative study of the

evel of hydrogen peroxide and superoxide produced

y peripheral blood phagocytes from normal healthy

ndividuals and lepromatous leprosy patients showed a

eficiency in super-oxide production in the patients. In

he phagocytes from normal healthy individuals, there

as good release of superoxide ions, and this

ediated the killing of M. lapse. The lack of

uperoxide production allowed the viability of M.

eprae inside the macrophages from leprosy patients.

his deficiency could be rectified by the use of an

mmunomodulator, the delipidified cell wall of M.

eprae. This modulations resulted In the ability of the

atients' phagocytes to respond to M. lapse, to

roduce reactive oxygen intermediates such as

uperoxide, and also to kill the bacteria. These

bservations indicate that delipidified cell wall could

ave significant potential to positively modulate the

mmune-deficient cells of leprosy patients.

MEYERS, W. M. at al. Histologic Responses in

ixty Multibacillary Leprosy Patients

noculated with Autoclaved Mycobacterium Leprae;

nt. J. Leprosy, 56(2):302-309, 1988


SUMMARY - Sixty lepromatous or borderline

lepromatous patients were submitted to

immunotherapy with a mixture of autoclaved

Mycobacterium leprae and BCG. The histopathologic

findings in skin biopsy specimmens taken before and

after immunotherapy were evaluated independetly by

six histopathologists in a workshop setting. Their

pooled observations on diagnosis and classification

were analyzed to assess the histopathologic changes

following various periods of immunotherapy.

Expressing the results as the average value of five to

six independent observations, there were changes in

classification of reversal or upgrading toward the

tuberculoid end of the leprosy spectrum in 90.5% of

the patients initially classified as lepromatous (LL), and

in 83.3% of those initially classified as borderline

lepromatous (BL). The histopathologic findings amply

support the clinical, bacteriologic and immunological

changes following immunotherapy from LL or BL, to

BL, mid-borderline (BB) or even borderline tuberculoid

(BT) leprosy.

MUUYIL, J. & THANGAVEL, N. Status of multi bacillary

patients "lost to follow up". Indian J. Leprosy,

61(2): 229-232, 1989.

ABSTRACT - Completeness of coverage with MDT

is essential if one were to hope for a reduction in the

incidence of leprosy in a endemic area. Patients who

are lost to follow up are generally declared as

"Permanently left" (PL) and deleted from the known

case register. A special effort was made to study the

true status of multibacillary patients who had been

declared "PL" in the leprosy control programme area

of the Christian Medical College, Vellore, 38% of the

40 patients followed up were found to be still residing

in the same area, 40% of them were BI Positive. The

reasons for these erroneous deletions varied. The

study shows that declaration of "PL" need to be

verified carefully. Further, it was found that the

present system of reporting may exaggerate the actual

number of patients who have been lost to follow up.

NOMAGUCHI, H. at al. Overproduction, Affinity

Purification and Characterization of 65-kDa

Protein of Mycobacterium leprae in Escherichia

coll. Int. J. Leprosy, 57(4):817-824, 1989.

SUMMARY - The 65kDa protein of

Mycobacterium leprae was produced in an Escherichia

coli strain carrying a plasmid harboring the redone

gene coding for the protein. The protein was purified

through affinity chromatography prepared with the

IgG fraction of a monoclonal antibody which was

prepared against the 65-kDa protein. The purified 65-

kDa protein also reacted immunologically with the

monoclonal antibody 111E9, which recognizes the

epitope for M. leprae, prepared by Buchanan, at al.

BALB/c mice were inoculated with M. leprae and 4

months later were skin tested with the purified 65-kD

protein. Gross changes were observed at the skin-test

site. The role of the protein in protective immunity

against M. leprae foot pad infection in mice was also

studied.

PORTAELS, F. at al. Effects of Freezing and Thawing

on the Viability and the Ultrastructure of in Vivo

Grown Mycobacteria. Int. J. Leprosy,

56(4):580-587, 1988.

SUMMARY - The influence of different

frequencies of freezing-thawing cycles on the viability

of in vivo grown mycobacteria was investigated. Pieces

of armadillo tissues naturally or experimentally

infected with Mycobacterium leprae were analyzed.

The viability of M. leprae was determined by mouse

foot pad titration. The viability of cultivable

mycobacteria, sometimes present in armadillo tissues,

was determined by culture. Electron-microscopic

studies were performed on fresh or frozen-thawed

armadillo tissues with natural leprosy and on livers of

C57BL/6 mice experimentally infected with /Aavium or

M. lepraemurlum. We found that the percentage of

viable M. leprae bacilli is identical for naturally infected

and experimentally infected tissues, frozen and

thawed once.

When the tissues were subjected to a second

freezing-thawing •cycle, a considerable loss of viability

was observed (65%-97%). A third freezing-thawing

cycle was lethal for most of the M. leprae cells, and

after four freezing-thawing cycles no viable bacilli were

found. The cultivable mycobacteria present in some

armadillo tissues were found to be more resistant than

M. leprae to freezing-thawing since these

mycobacteria could still be cultivated after four

freezing-thawing cycles. The results of the electron-

microscopy study support the conclusion that M.

leprae is more sensitive to freezing-thawing than the

cultivable mycobacteria and show that the cytoplasmic

Hansen. Int. 14(2):170-180,1989

membrane appears to be the target for the lethal

action of freezing-thawing on mycobacterial ..ails.

These results emphasize the importance of avoiding

repeated thawing and refreezing of M. leprae-infected

tissues when viable M. leprae cells need to be studied.

Also, the history of each sample regarding the number

of freezing-thawing cycles must be precisely recorded

in order to anticipate the quality of the samples in

terms of viability of the leprosy bacilli.

RAO, P. S. at al. A study into bacteriological positivity

and treatment of beggar leprosy patients. Indian J.

Leprosy, 61(2):216-221, 1989.

ABSTRACT - Hundred beggar leprosy patients

were medically examined and skin smears were taken

for bacteriological positivity for A.F.B. Information

regarding their treatment was collected. 20% of them

were found bacteriologically positive and 40% of the

positive cases were not taking treatment

Epidemiological and operational implications of the

findings are discussed.

REDDI, P. P. at al. Repetitive DNA Sequence of

Mycobacterium tuberculosis: Analysis of

Differential Hybridization Pattern with Other

Mycobacteria. Int. J. Leprosy, 56:592-598,

1988.

SUMMARY - In order to generate specific DNA

probes for Mycobacterium tuberculosis, restriction

fragment length analysis was carried out with some of

the mycobacterial species that fall within the

tuberculosis complex. The presence of specific bands

of 5.6 kb and 4.8 kb was revealed In the Alul DNA

digest of M. tuberculosis. The hybridization profile of

the 5.6-kb Alul DNA sequence, as judged by the

Southern blot and dot blot hybridization experiments,

revealed the presence of this sequence in M.

tuberculosis H37Rv, M. tuberculosis H37Ra, M. bovis

BCG as multiple copy and M. kansasifas single copy

but this sequence was not present in M. avium, M.

smegmatls, or M. vaccae genomes. Genomic

178

Hansen. Int. 14(2):170-180,1989


clones corresponding to the 5.6-kb Alul fragment from

M. tuberculosis H37Rv library made in the Dgt11

expression vector were isolated.

ROJAS-ESPINOSA, O. et al. Transitory

Macrophage Activation in the Granulomatous

Lesions to Mycobacterium lepraemuriun-induced

Lepromatoid Leprosy in the Mouse. Int. J.

Leprosy, 56(3):428-436, 1988.

SUMMARY - A kinetic study on the evolution of

granulomas that appear in the liver of.NIH mice

inoculated with 108 Mycobacterium lepraemurium by

the intraperitoneal route has been performed. The

liver was chosen because of its nonlymphoid histology

which allowed us to visualize the appearance and

maturation of the cell infiltrates generated as a

consequence of the mycobaderial infection. The study

analyzes both the macrophage activation within the

granulomas and the fate of bacilli within the

macrophage. The results showed that this

mycobacteriosis induces a relatively early macrophage

activation (a very likely result of a cell-mediated

immune response triggered by the bacilli) that peaks

between 45 and 60 days post inoculation, fades

thereafter, and practically disappears several days

later. Bacilli are susceptible to the microbicidal effects,

of activated macrophages, but when the macrophages

are turned off (probably due to active supressive

mechanisms), the surviving bacille reinitiate the

infection with no further macrophage opposition. As a

result, more phagocytes are attracted to the infection

sites and the cell infiltrates grow steadily to become

confluent, increasing the granuloma fraction and

eventually replacing the liver parenchyma. The

findings suggest that In murine "leprosy" infection,

early immunological changes occur that enable the

macrophages present In the granulomas to kill the

infecting M. lepraemurium regardless of the eventual

lepromatoid evolution of the granulomas. Lepromatoid

granulomas in the mouse and lepromatous

granulomas in man are equivalent structures in regard

to their histology and bacteriology.

RUNGRUANG, S. Further observations on the breeding

and rearing of BALB/C nude (nunu) mice under

normal laboratory conditions. Leprosy Rev.,

59:25-30, 1988.


SUMMARY - An account is given of the breeding

and rearing of BALB/C (nu-nu) mice under normal

laboratory conditions, in a research institute in

Thailand. Starting with twenty pairs of mice in 1980

over 4.000 have now been successfully bred and

reared in this uniti on reaching adult age (30 days),

the mortality rate is nil.

A detailed description is given of the housing

unit, cages, bedding, diet, animal husbandry and

neonatal management. The approach used is

demanding in terms of professional time and the need

for constant attention to detail - but it is successful.

Our experience is in striking constrast to

published evidence on the absolute need for specific

pathogen-free conditions of this animal model.

SAMUEL, N. M. et al. Ultrastructure of human foetal

Schwann cells in tissue culture infected with

Mycobacterium leprae. Leprosy Rev., 59:17-24,

1988.

SUMMARY - Human Schwann cells from foetal

peripheral nerves were grown in tissue culture and

infected with Mycobacterium leprae. After fixation for

electron microscopy the ultrastructural features of

infected Schwann cells were studied. The findings

reproduce previous ultrastructural findings of adult

human Schwann cells in tissue culture and clearly

demonstrate that M. leprae cultured Schwann cells.

Most of the M. leprae remained electron dense,

suggesting retained viability, and did not appear to

induce any toxic change in the Schwann cells.

SANCHEZ, A. & FOSTER, R. L. Effects of dietary

composition on growth of M. leprae in mouse

footpads. Indian J. Leprosy, 61(4):432-436,

1989.

ABSTRACT - The number of bacteria per mouse

footpad were measured at intervals beginning with the

third month in male, wealing BALB/c mice infected

with M. leprae and fed for a period of 6 months to test

the effects of diet on multiplication of bacteria. The

mean bacteria count per foot pad in mice remaining at

6 months in the two high fat diets was higher (p =

0.014) than the mean of the two low fat diets.

Likewise, the pooled mean bacterial count of mice fed

the two diets of animal origin had a tendency to a

higher mean

bacterial count compared to mice fed the two diets of

plant origin. Low level of dietary protein in early life

also seemed to predispose to M. leprae multiplication.

Our data in mice suggest that the association of diet

with human leprosy should be investigated.

SILVA, M. T.; PORTAELS, F. & MACEDO, P. M. New

Data on the Ultrastructure of the Membrane of

Mycobacterium leprae. Int. J. Leprosy,

57(1):54-64, 1989.

SUMMARY - In previous reports on the

ultrastructure of Mycobacterium leprae, we described

the occurrence of symmetric membranes in normal-

looking bacilli from fresh or frozen samples primarily

fixed with aldehydes. In those reports we admitted

that such a symmetric profile, which is not found in

the other normal mycobacteria, would not represent

the structure of the normal membrane of the leprosy

bacillus. We, therefore, re-analyzed the ultrastructure

of the membrane of M. leprae. In the present work

the micromorphology of the M. leprae membrane was

studied by transmission electronmicroscopy ater the

fixation of fresh samples by 0504 plus calcium

followed by glutaraldehyde plus formaldehyde and

calcium followed by uranyl acetate. The study of

samples from two patients with lepromatous (LL)

leprosy, three armadillos with natural leprosy, and one

nude mouse with experimental leprosy showed that

normal-looking bacilli present in lead-stained sections

had asymmetric membranes with a thickness of 6.49

+- 0.36 nm. These membranes showed periodic acid-

Schiff (PAST-positive components exclusively located

in the outer half of the bilayer. We demonstrated that

the symmetric profile of the M. leprae membrane

described in our previous reports corresponds, as

admitted in those reports, to an abnormal membrane

structure. Such an abnormality was now found to

result from the use of primary fixation with aldehydes

or of samples stored frozen before fixation. These

results indicate that, although ultrastructurally similar

to that of the other mycobacteria, the membrane of M.

leprae has a peculiar sensitivity to fixation by

aldehydes. Such a characteristic, which was not found

in M. lepraemurium, M. aururq M. avium, and M.

tuberculosis H37Ra, must reflect a unique membrane

molecular structure, which is presently unknown.

Hansen. Int. 14(2):170-180,1989

SINGH, N. B. et al. Relative cross reactivity of habanin,

lepromin and tuberculin in guineapigs sensitized with

homologous and heterologous mycobacteria. Indian

J. Leprosy, 60(3):407-412, 1988.

ABSTRACT - An atypical strain Mycobacterium

habana has been studied for its antigenic cross reactivity

with delayed type of hypersensitivity responses in guinea

pigs. Guineapigs sensitized with M. habana, M. leprae and

M. tuberculosis when challenged with habanin, lepromin

and tuberculin in criss-cross fashion have demonstrated

strong cross reactivity with each other. Possibilities of

developing M. habana as a vaccine against tuberculosis

and/or leprosy has been discussed.

SMIDA, J.; KAZDA, J. & Stackebrandt, E. Molecular-

Genetic Evidence for the Relationship of

Mycobacterium leprae to Slowgrowing Pathogenic

Mycobacteria. Int. J. Leprosy, 56(3):449-454,

1988.

SUMMARY - A total of 1170 nucleotides of the 16S

rRNA from Mycobacterium leprae were compared to the

homologous regions of M. tuberculosis, M. bovis Vallée, M.

avium, M. scrofulaceum, ML phlei, M. fortuitum and one

representative each of the genera Corynebacterium,

Nocardia, and Rhodococcus. Homology values were

calculated and a phylogenetic tree was constructed from

the evolutionary distance values. Despite differences in

DNA G + C content and genome size, M. leprae is a true

member of the slowgrowing pathogenic mycobacteria,

branching off intermediate to the other members of this

subgroup. Slow-and fast-growing mycobacteria are

phylogenetically well separeted but constitute an

individual branch of the actinomycetes proper. Significant

structural variation of certain regions of the 16S rRNA may

allow construction of M. leprae-specific probes used for

rapid identification.

SREEVATSA & DESIKAN, K. V. Evaluation of the efficacy of

candidate vaccines against M. leprae infection in

mice. Indian J. Leprosy. 60(2): 252-259, 1988.

ABSTRACT - Delayed-typed hypersensitivity (DTH)

response and protection value of some of the candidate

vaccines alone and in combination with BCG has been

investigated. It was observed that both M.w. and BCG

gave hightened DTH and good protection. On the other

hand both M. leprae and ICRC evoked moderate DTH and

gave poor protection. However on coming any of these

candidate vaccines with live BCG, the lowering of DTH and

poor protection was observed except in the M. leprae

combination which inspite of low DTH gave better

protection.

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OMIOKA, H. at al. Susceptibilities of Mycobacterium leprae

and M. avium complex to the H202 -Fe-mediated

Halogenation System Supplemented with

Antimicrobial Agents. Int. J. Leprosy, 57(3):628-

632, 1989.

SUMMARY - The susceptibilities of

Mycobacterium leprae and M. avium complex (MAC) to

the H 2-02-Fe. mediated halogenation system

supplemented with antimicrobial agents were evaluated

by fluorescein diacetate-ethidium bromide (FDA/EB)

staining. In the case of M. leprae, the number of green-

stained bacteria (intact cells) was reduced in the

presence of the H202-Fe-mediated halogenation system

supplemented with agents possessing antileprosy

activity, such as rifampin, 4,4' -diaminodiphenylsufone

(dapsone), clofazimine, and ofloxacin. In the case of the

MAC strain, although viable units of the organisms were

reduced by the Ihalogenation system alone, the number

of green-stained cells in the FDA/EB stain was not

reduced, even when the halogenation system was used

in combination with ofloxacin. Because stainability of the

cells is related to structural and functional intactness of

the membrane, differences between M. leprae and the

MAC strain imply possible differences in the rigidity of the

cell membrane.

TZE-CHUN, L; ZHONG-MIN & SKINSNES, O. K. Light-and

Electron-microscopic Study of M. leprae-infected

Armadillo Nerves. Int. J. Leprosy, 57(1):65-72,

1989.

SUMMARY - Lesions in peripheral nerves of

rmadillos experimentally infected with Mycobacterium

eprae were studied by light- and electron-microscopy.

acilli could be found clearly inside axons of unmyelinated

erve fibers. Heavily bacillated Schwann cells were seen

mbracing unmyelinated axons with interrupted

ytoplasmic membranes. This indicated the initiation of

upture of those cells which were responsible for the

iberation of bacilli into the axons. The nerve lesions were

ivided into three grades according to their severity:

rade I showed lesions focalized in the perineurium;

rade II lesions were scattered inside nerve tissue; and in

rade Ill lesions the nerve tissues were diffusely affected.

o regressive changes, such as fibrosis or scar formation,

ere seen in the nerve lesions. Bacillated macrophages

ere not as foamy as those of human lesions, indicating

hat these bacillated cells were younger or more easily

isrupted with a higher turnover than the cells in human

esions. This would promote the spread of lesions In

rmadillos, and would explain the less foamy appearance

f the cells. We found bacilli inside lymphatics surrounding

he nerves, substantiating the opinion that lesions spread

o peripheral nerves not only by a hematogenous route

ut also by the lymphatics.

GIRDHAR, M. et al. Pattern of leprosy disabilities in

Goraklpur. (Uttar Pradesh). Indian J. Leprosy,

61(4):503-513, 1989.

ABSTRACT - Out of 514 leprosy cases studied,

229(44.56%) had disability. Disability was most

commonly seen in lepromatous leprosy. There was an

increasing trend in disability with increasing age of

patient and duration of disease. Disability rate was

higher in males as compared to females. Nerve

thickening and reactional states were more common

in disabled cases. Dapsone treated group showed a

disability rate of 63.8% as compared to 30.0% in

untreated group. Hand was the most commonly

affected site and mobile claw hand was the single

most common disability. The overall disability index-

D.I. (2) of Bechelli was 1.25 and lepromatous cases

had highest D.I. (1.89). Disability index was higher in

males and was found to increase with increasing age

of patient and duration of disease.

HAMMOND, C. J. & KLENERMAN, P. Protective

sensation in the foot in leprosy. Leprosy Rev-,

59:347-354, 1988.

SUMMARY - Plantar ulceration is a significant

problem in leprosy patients and accounts for a large

proportion of hospital admissions. Three methods of

sensory testing were employed to see if a high-risk

group of people with loss of protective sensation

might be selected, so that the serious first ulcer migh

be prevented. Three groups of patients were studied:

41 leprosy patients with ulcers, 41 without ulcers and

48 control subjects without leprosy. The results show

that either or both Semmes-Weinstein nylon

monofilaments and biosthesiometer may prove a

more reliable method of sensory testing than the

standard WHO pencil stimulus.

KAPLAN, M. & GELBER, R. H. Care of plantar

ulcerations: comparing applications, materials

and non-casting. Leprosy Rev., 59:69.66,

1988.

SUMMARY - We have reviewed our experience

with plantar ulcer care in our population of 525

patients treated between 1982 and 1987. Patients

were treated with standard plaster of Paris casts,

alternative methods of casting, and without casting.

Of the 24 patients who received casts, all

healed, while 23 of the 30 patients healed without

casting. The average healing time for those who were

tested was 5.6+-2.6 weeks and for those uncasted,

8.1+-6.6 weeks (P = 0.1). It was concluded that

ulcers can heal without casting and that alternative

casting procedures offer certains significant

advantages. Such approaches are especially

applicable to the current leprosy population being

treated in the community and remaining ambulatory.

MAX, E. & SHEPARD, D. S. Productivity Loss Due to

Deformity from Leprosy in India. Int. J. Leprosy.

57(2):476-482, 1982.

SUMMARY - The productivity loss in India due to

deformity from leprosy was assessed in a random

sample of 550 leprosy patients from a rural and an

urban area in the state of Tamil Nadu. Logistic and log-

linear regression analysis on these leprosy patients

showed that elimination of deformity would: a) raise

the probability of gainful employment from 42.2% to

77.6%; b) increase annual earnings per patient

gainfully employed from Rs 2948 to Rs 6469; and c)

raise overall earnings for all patients from Rs 1259 to

Rs 5023 per year. The earnings of 550 control subjects

(adult family members of the leprosy patients) were

consistent with these predictions. Extrapolation to all of

India's estimated 6-5,000 leprosy patients with

deformity suggests that elimination of deformity would

raise productivity by $130 million per year. The authors

conclude that the development and evaluation of

programs to eliminate deformity from leprosy deseve

high priority.

MISHRA, B. et al. Leprosy deformities. I. An

epidemiological study in a rural area of Rajasthan.

Indian J. Leprosy, 60(1):53-62, 1988.

ABSTRACT - Leprosy deformities have been the

cause of dehabilitation, destitution and social ostracism.

Present study was planned and conducted in a rural

area situated in eastern districts of Rajasthan. Out of

426 cases of leprosy, ninety cases were found suffering

with deformities. The influences of various host factors

and disease factors, In causation of deformities have

been discussed.

Hanseníase: Resumos/Hanseníasis Abstracts - PREVENÇÃO DE INCAPACIDADES 181

Hansen. Int. 14(2):181-182,1989

MIS HRA, B. et al. Leprosy deformities. II. As

parameters to monitor the effectivity of leprosy

control programme. Indian J. Leprosy,

64(2):260-266, 1988.

ABSTRACT - Leprosy deformities have been

considered as the main reason for dehabilitation and

social ostracism. Prevention of deformities is

considered as one of the most important objectives of

leprosy control programme. In present work based on

deformity status, efforts have been made to evolve

new parameters and their possible apllicatlon in

assessment of leprosy control programme.

NAIK, S. S. et al. Involvement of students in a leprosy

health education programme - an experiment

Leprosy Rev., 59: 255-258, 1988.

SUMMARY - The students participation at college

and high school level can be obtained for leprosy

health education programmes if proper motivation is

given, involving non-leprosy agencies such as the

student community will help to overcome the stigma

of leprosy In society. The experiment of 'Involvement

of College Volunteers' and 'Mitra' are described and

have the potential to spread to other regions.

OKHANDIAR, R. P. at al. Morphometric study of

stratum corneum in leprosy. Indian J. Leprosy,

61(1):49-51, 1989.

ABSTRACT - Abnormalities in Stratum Comeum

(SC) In leprosy lesions have been demonstrated as

evidenced by poor hydration power of SC and

increased SC turn-over. In continuation of the same

study morhphometric studies of the SC in leprosy was

undertaken as per measurement of the Thickening of

the SC, Mean

182

Hansen. Int. 14(2):181-182,1989


epidermal thickness and Basal layer: Granular layer cell

ratio (8:G ratio) of the H.E. stained tissues, Further, on

freshy frozen tissues the SC cell-layers were also

counted.

The findings suggest increased proliferative

activity of the epidermis which may lead to formation

of defective SC in leprosy.

SHOREY, P. at al. Ocular changes in reactions in

leprosy. Leprosy Rev., 60(2): 102-108, 1989.

SUMMARY - A study of ocular changes in

reactions in leprosy was undertaken to assign these

changes, their proper place in the wide spectrum of

ocular morbidity in leprosy, 76.1% of eyes of Type I

reaction and 89.7% of eyes with Type II reaction

showed some ocular involvement Corneal

hypoaasthesia, superficial punctate keratitis, a

decrease of corneal film break up time (BUT),

prominent comeal nerves, pigment on the endothelium

of the cornea and a pigmented trabecular meshwork

were the common ocular findings. The incidence of

iridocyclitis In Type II reactions was low (8.1%). The

significance of the ocular Involvement in reactions in

leprosy and the pathogenesis of iridocyclitis in Type II

reactions is discussed.

SIRINIVASAN, H. Do we need trials of agents

alleged to improve healing of plantar ulcers? Leprosy

rev., 60(4):278-282. 1989.

SUMMARY - The assumptions urderlying trials of

agents claiming to heal plantar ulcers 'faster' and

'better' are shown to be fallacious and it is pointed out

that in most cases these ulces fail to heal for lack of

attention and not for want of a specific topical agent

Clinical trials in this area are difficult and are not worth

the trouble as they do not add our knowledge about

these ulcers or their management in the clinic or In

the field.

Hanseníase: Resumos/Hanseníasis Abstracts - REABILITAÇÃO 183

BEINE. A.O.; SAMPATH, S. R. & CORDEIRO, R. A.

Modification of the surgical correction of the thumb

- a long term follow up. Indian J. Leprosy,

61(1):17-22, 1989.

ABSTRACT - A modification of the commonest (4)

surgical procedure to restore Abduction - Rotation

using the flexor superficialis transfer with Y-insertion is

described. The modification consists of doing a triple

insertion at the thumb instead of Y-insertion. After

introducing the triple insertion the procedure shows

80-90% or more good results, whereas 50% or more

failures are reported in the existing literature (9),

when a Y-insertion only is used which cannot safely

prevent 2' deformity, 60 cases were followed up.

RAO, V. A. & KAWATRA, V. K. Cataract extraction in

leprosy patients. Leprosy Rev., 59:67-70, 1988.

SUMMARY - Forty-one eyes of 36 leprosy patients

were operated on for cataracts. The ocular findings

contributing to blindness among the 41 operated eyes

were corneal opacity (26.8%), old uveitis (36.6%) and

glaucoma (7.3%). Shallow anterior chamber in the

early postoperative period was observed in 26.8% of

cases. The use of systemic corticosteroids definitely

reduced the incidence of postoperative uveitis (2.4%).

Thirty-seven (90.24%) eyes showed improvement in

their visual acuity of two Snellen's lines or more after

surgery. We conclude that cataract surgery may help

in rehabilitation of already disabled and handicapped

leprosy patients.

RAO, K. S. & SWAMY, M. K. S. Sensory recovery in the

plantar aspect of the foot after surgical

decompression of posterior tibial nerve. Possible

role of steroids along with decompression.

Leprosy Rev., 60(4): 283-287, 1989.

SUMMARY - In leprosy, Involvement of the

posterior tibial nerve leads to sensory loss in the

plantar aspect of the foot. As a result plantar ulcers

are common and lead to deformity and disability.

Restoration of plantar sensation can prevent ulcer

formation.

Posterior tibial decompression was done for the

recovery of sensation in the plantar aspect of the foot.

Seventy-two patients underwent went decompression

on 84 feet, 25 received steroids pre and post-

operatively. The recovery of sensation was better if

surgery was done before 6 months of onset of

anaesthesia. Decompression alogn with steroid gave

better results than decompression alone in patients

with active neuritis especially in BT cases whereas in

BB, BL and LL cases there was no significant

improvement of sensation. The results are discussed.

SURYAWANSHI, N. & RICHARD, J. Cataract Surgery on

Leprosy Patients. Int. J. Leprosy, 56(2):283-

242, 1988.

SUMMARY - All patients who had cataract surgery

at the Schieffelin Leprosy Research and Training

Centre, Karigiri, India, between January 1979 and

April 1985 were studied to find out the outcome of

that surgery. These patients included 191 leprosy

cases and 89 nonleprosy cases. Postoperative

complications were slightly higher amoung leprosy

patients compared to the nonleprosy cases. Visual

recovery was marred by preoperative corneal opacities

in some of the leprosy patients. Eyes with chronic

insidious type of iridocyclitis did not produce any

devastating results postoperatively. Patients whose

skin smears were still positive for leprosy bacilli did not

show any major complication. All leprosy patients

should be offered the benefit of cataract surgery for

restoring sight because blindness in leprosy would

mean a double handicap if they are already suffering

from insensitive, deformed hands and feet.

Hansen. Int. 14(2):183,1989

ASCHHOFF, M. et al. Secondary and primary dapsone

resistant leprosy: an analysis of 199 patients

from St. Thomas Hospital and leprosy project,

Chettupattu, South India. Indian J. leprosy,

60(1): 34-46, 1988.

ABSTRACT - The occurrence of secondary and

primary dapsone resistance in 199 patients in our

control area and the influence of certain variables

such as age, initial bacteriological and morphological

indices, duration of regular dapsone monotherapy, on

the emergence of dapsone resistance was

investigated. Ninety one of 122 patients and 29 out

of 77 showed secondary (SDR) and primary (PDR)

resistance to dapsone respectively. Very low BI

(B1:2.5) group also showed both SDR (60%) and

PDR (40%). Low or high MI group exhibited the

same degree of resistance. Multiplication of M. leprae

was obtained even when the MI of the inocula was

zero. Even in the group who had 1 to 5 years

duration of regular dapsone treatment, 85% patients

showed SDR. Significance of such results are

discussed in relation to chemotherapy. The overall

minimum prevalence of SDR was found to be 5.6%

and 21% in the case of PDR in our control area.

AYTEKIN, A. H. & SAYLAN, T. Close-contact surveys

and mass-screening, studies for leprosy in

Turkey. Leprosy Rev., 59:225-229, 1988.

SUMMARY - Beginning in 1984, the Department

of Dermatology at Istanbul University Medical School

and the Department of Public Health of Uludag

University Medical School embarked on: a, close

contact surveys; and b, mass-screening studies in the

Province of Van in Turkey. Methodology and resutts

are described in detail. The total number of cases in

the whole country is unlikely to exced 4300 and

leprosy cannot be considered to be a serious public

health problem. However there is room for

improvement, notably in compliance to prescribed

medication, the reduction of disability rates and the

better use of general health units.

BALAKRISHNAN, S.; KARTHIKEYAN, S. & RAMU, G.

Investigations into the haemolytic effects of

dapsone therapy in leprosy patients. Indian J.

Leprosy, 61(1):10-16, 1989.

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Hansen. Int. 14(2):184-199,1989


BSTRACT - Investigations into the haemolytic effects

f dapsone therapy were carried out in forty four

eprosy patients admitted to the Sacred Heart Leprosy

entre, Kumbakomam. They received weight based

apsone dosages varying from 1.3 - 3.3. mg/kg body

eight. Blood levels an urinary Dapsone/creatinine

atio were assessed at day, 7 days and 30 days of

apsone treatment At the same point of time,

aematological observations were also carried out.

erum bilirubin as well as blood mathaemoglobin were

lso examined. The findings showed a reduction in Hb

evels at 30 days observation in a good proportion of

ases on 100 mg. In one case (child) weighing 15 kg

nd receiving 50 mg dapsone increased

athaemoglobin was observed. It is suggested that

apsone dosage be regulated to body weight and

referably not to exceed 1.5 mg/kg body eight

HATNAGAR, P. at al. Dapsone drug compliance study

among leprosy patients: a comparison between

qualitative and quantitative methods. Indian J.

Leprosy, 61(3):373-378, 1988.

ABSTRACT - The methods currently employed to

onitor self-administration of dapsone have been

valuated by comparing the results of the qualitative

pot test and quantitative DDS/creatinine ratio test.

andom urine samples of 242 leprosy patients,

eriodically attending the Leprosy Clinic were tested.

Although a good correlation between the results

f the two was evident, the DDS/creatinine ratio

echnique appeared to be more sensitive than the spot

est. The concentration of DDS and its metabolites in

rine specimens found to be negative by the spot test,

anged from 3.32-12.37 mg of DDS/mg creatinine.

he spot test was found to be more specific and stays

o be the method of choice, when rapidity and

eproducibility are the prime objectives, and sensitivity

an be marginaly compromised. Acidification of urine

rior to the spot test was found to be desirable to rule

ut falso negative and false positive reactions.

OERRIGTER, G.; PONNIGBAUS, J. M. & FINE, P. E.

M. Preliminary Appraisal of a WHO-recommended

Multiple Drug Regimen in Paucibacillary Leprosy

Patients in Malawi. Int. J. Leprosy, 56(3):408-

417, 1988.

Hanseníase: Resumos/Hanseníasis Abstracts - TERAPÊUTICA 185

SUMMARY - A study was undertaken within the

framework of the LEPRA Evaluation Project and the

LEPRA Control Project in Malawi (Central Africa) to

study the incidence rates of type 1 reactions and of

relapses in paucibacillary leprosy patients treated

with the current World Health Organization-

recommended multiple drug regimen (WHO/MDT). Of

503 patients recruited into the study, 488 were

reviewed at the end of treatment and 480 have now

been followed for 1 year after completion of

treatment. At the end of treatment the skin lesions

had completely disappeared in 27.4%, but were

judged to be still active in 4.3%. During the follow-up

period two patients were found with new active skin

lesions, giving a relapse rate of 4.17 (2 of 480) per

1000 person years during the first year after

completion of WHO/MDT (95% confidence interval

1.14 to 15.06 per 1000 person years). The incidence

rate of marked type 1 reaction (renewed

inflammation in previously Inactive lesions) during

the first year after completion of WHO/MDT was 47.8

per 1000, person years in self-reporting patients but

zero in patients identified by active case finding. Data

are presented which suggest that the incidence rate

of late type 1 reactions is closely related to the

classification and stage of the disease at detection.

CARTEL, J. et al. Implementation of

Chemoprophylaxis of Leprosy in the Southern

Marquesas with a Single Dose of 25 mg per kg

Rifampin. Int. J. Leprosy, 57(4):810-816, 1989.

SUMMARY - Between 1967 and 1987 in the

Southern Marquesas, a remote archipelago in French

Polynesia, the detection rate of leprosy as 48.9 per

10.000 when it was 8.6 per 10.000 for French

Polynesia as a whole. In 1988, a program of

chemoprophylaxis of leprosy with a single dose of 25

mg/kg rifampin was implemented, and 2751 persons

(98.7% of the population) were treated in he

Southern Marquesas. In addition, 678 South

Marquesans and 2466 members of their families,

living in the Northern Marquesas and in the Society

Archipelago, received the same chemoprophylaxis.

Among 2676 persons studied in the Southern

Marquesas (97.4% of the treated population), 130

had elevated IgM anti-phenolic glycolipid-I antibodies

by ELISA without any evidence of leprosy. The onset

of a skin lesion of borderline leprosy in a boy 3

months after chemoprophylaxis raises the question of

the nature of such a skin

lesion and, indirectly, of the effectiveness of the

chemoprophylaxis.

CHANTEAU, S. et al. PGL-I Antigen and Antibody

Detection in Leprosy Patients: Evolution Under

Chemotherapy. Int. J. Leprosy, 57(4):735-743,

1989.

SUMMARY - Multibacillary (MB) and paucibacillary

(PB) leprosy patients were tested for circulating

phenolic glycolipid-I (PGL-I) antigen and antibodies

before treatment. In the 27 MB patients tested, 27

(100%) were antigen positive with levels ranging from

50 to 5000 ng/ml, and 26 (96%) were antibody

positive with titers ranging from 1000 to 64,000.

Although the antigen and antibody levels were much

higher in MB than in PB patients, we could not

demonstrate a correlation between the number of acid

-fast bacilli/mg of skin biopsy and these two

parameters In 14 MB patients. After starting daily

multidrug therapy, 10 MB patients were monitored

monthly. As much as 88.75% +10.8% of the PGL-I

antigen was cleared from the bloodstream after 1

month while the anti-PGL-I antibody remained stable.

This rapid decrease in the PGL-I antigen level strongly

suggests the usefulness of this test for monitoring MB

patients under chemotherapy.

SCIENTIFIC Working Group of the UNDP/World

Bank/WHO. Characteristics of the multiplication

of dapsone-resistant strains of Mycobacterium

leprae in mice. Leprosy Rev., 59:5-10, 1988.

SUMMARY - Twenty-seven per cent of the 49

strains of Mycobacterium leprae isolated in the course

of the THELEP controlled clinical trials of combined

chemotherapy of lepromatous leprosy in Bamako and

Chingleput, and found to be resistant to dapsone

multiplied in significantly fewer mice administered

dapsone than in mice administered the dapsone-free

diet.

CHATTOPADHYAY, S. P. at al. Evaluation of two

multidrug regimen in hospitalised multibacillary

cases. Indian J. Leprosy, 61(2):196-205, 1989.

Hansen. Int. 14(2):184-199,1989

ABSTRACT - Fifty theree multibaclllary leprosy

cases were treated with two regimens of MDT L1

consisting of Rifampicin, Dapsone and Ethionamide

and L2 consisting of Rifampicin Dapsone and

clofazimine. The results were compared at regular

intervals and at the end of the study (24 months).

Clinical inactivity, bacteriologic negativity, ENL

reactions, upgrading reactions were seen in L1 group

in 65%, 4,54%, 50% and 41% of cases respectively

while 65%, 25.8%, 30% and 45% respectively in L2

regimen group. Zero percent morphological Index was

achieved in all cases in L1 regimen 90% in L2 regimen

cases.

No viability was found on mouse foot pad

inoculation after months In L1 while after 18 months

in L2 cases.

CHERIAN, E. at al. Bacterial flora of ulcers treated by

three types of dressings. Indian J. Leprosy,

60(3):389-392, 1988.

ABSTRACT - Effect of three types of dressings on

bacterial flora in ulcers is presented. Debrisan seemed

to be more effective than Zinc tape and collagen sheet

in reducing the number of bacterial pathogens.

CHOPRA, N. K.; AGARWAL, J. S. & PANDYA, P. G.

impact of multidrug therapy on leprosy in Baroda

District (Gujarat). Indian J. Leprosy,

61(2):179-189, 1989.

ABSTRACT - Though much information is

available on MDT organising, it poses a challenge to

the field staff due to limited field trials conducted and

varied field conditions.

The MDT project was begun on 11th June, 1984

in Baroda by the Govt, of India, with active assistance

of State Government, the World Health Organisation

and the Swedish international Development Agency.

The Drug combinations for MB cases were Rifampicin

600 mg, Clofazamine 300 mg and dapsone 100 mg

daily for 14 days intensive supervised therapy followed

by once a month (Pulse) supervised dose of Rifampicin

100 mg, Clof. 300 mg and dapsone 100 mg for

minimum period of 2 years or more if indicated and

Clof 50 mg daily with dapsone 100 mg daily

unsupervised for minimum period of 2 years or more if

indicated, for PB cases, dapsone 100 mg daily for 6

months alongwith 600 mg supervised (Pulse) once a

month

D

186

Hansen. Int. 14(2): 184-199,1989


for minimum period of 6 months or more if indicated.

EENABANDHU, A. & KOTHANDAPANI, V. G.

Paucibacillary primary dapsone resistance - a

case report. Indian J. Leprosy, 60(1):100-105,

1988.

ABSTRACT - A Case of primary paucibacillary

Dapsone resistance was presented. Its clinical

suspicion and diagnosis are stressed. Emergence of

dapsone resistance and its implications are shortly

reviewed. A shorts note on its prevention is

discussed. Literature is briefly reviewed.

DHANAPAUL, S. DDS - Induced photosensitivity with

reference to six case reports. Leprosy Rev.,

60(2): 147-150, 1989.

SUMMARY - Photosensitivity as an adverse

reaction to DDS was recognized in 6 patients of our

hospital during the summer of 1988. The clinical

manifestations and also the management of those

patients are given in detail. All doctors and health

workers involved with leprosy need to be aware of

such a problem and to take correct decision after

weighing the risk photosensitivity against the

potential benefit of DDS.

DHANDAYUTHAPANI, S. & BHATIA, V. N. Lactate

dehydrogenase isoenzymes in leprosy patients

on multi drug therapy - a preliminary report.

Indian J. Leprosy, 60(2): 196-201, 1988.

ABSTRACT - Serum LDH (total) and LDH

isoenzymes were studied in leprosy patients

undergoing multidrug treatment. Serum LDH (total)

did not show any significant difference between

normal human subjects and patients but LDH

isoenzymes have shown elevated levels in LDH4and

LDH5 in leprosy patients. The M/H ratios were high in

leprosy patients and they exhibited a further rise in

patients on treatment.

DIXIT, V. B.; CHAUDHARY, S. D. & JAIN, V. K.

Clofazimine induced nail changes. Indian J.

Leprosy, 61(4): 476-478, 1989.

Hansenfase: Resumos/Hansenfasis Abstracts - TERAPÊUTICA 187

ABSTRACT - Two cases of lepromatous leprosy

with erythema nodosum leprosum who were on high

doses of clofazimine, showed discoloration of nail

plate, subungual hyperkeratosis and onycholysis.

These nail changes gradually disappeared when the

dose of clofazimine was reduced.

DOUGLAS, J. T. at al. The effects of chemotherapy on

antibody levels in lepromatous patients. Leprosy

Rev., 59:127-135, 1988.

SUMMARY - We compare whole cell ELISA

antigens (Mycobacterium Ieprae)and two specific

antigens: PG-I, phenolic glycolipid I of M. leprae and

M-BCG, a synthetic antigen representing the terminal

sugar of PG-I for their effectiveness in detecting

antibody during chemotherapy. By the end of the 1st

year of treatment, antibody levels to M-BCG had

declined by 42% of the initial EUSA values, by end of

the 2nd year by 61% and at the end of 3 years by

68%. Declines of similar magnitude were seen with

the other antigens. We examined these sera by RID

for changes in levels of IgG, IgM and Ig antibodies.

The levels of IgG remained abnormally high

throughout the 3 years of antimicrobial therapy. The

serum levels of IgM and Ig antibodies remained at the

upper limits of normal range. The decline seen with

antibody to M. leprae antigens was not reflected by a

similar decline of serum immunoglobulin levels. Thus,

application of ELISA monitoring during the coursee of

treatment may be valuable in measuring the

effectiveness of chemotherapy.

DOUGLAS, J. T. et al. Evaluationof Mycobacterium

leprae antigen in the serological monitoring of a

clofazimine-based chemotherapeutic study of

dapsone resistant lepromatous leprosy patients in

Cebu, Philippines. Leprosy Rev., 60(1): 8-19,

1989.

SUMMARY - Thirty-one dapsone resistant

lepromatous lepromatous leprosy patients receiving

clofazimine based therapy were serologically

monitored throughout their 5-year period of

treatment. Sequentially collected sera were used to

examine 4 Mycobacterium leprae antigens to evaluate

their usefulness in EUSA's for monitoring the progress

of their therapy. The ELISA results were

compared with decline in bacterial load over the

treatment period and with decline and with duration

of treatment. In addition the ELISA's were compared

with each other. The ELISA's based on the

measurement of IgM antibodies to the two

neoglycoproteins (NDO and NTO) representing the

phenolic glycolipid antigen of M. leprae were found to

be the most effective with regard to monitoring

treatment. A whole M. leprae based ELISA was less

efficient in monitoring treatment because it failed to

measure antibodies in 5 out of 31 patients. The

ELISA-inhibition test based on the detection of

antibodies to a species-specific epitope on the 36Kd

antigen of M. leprae was less suitable because of

persistent reactivity during therapy.

EKAMBARAM, V. & RAO, M. K. Changing picture of

leprosy in North Arcot District, Tamil Nadu after

MDT. Indian J. Leprosy. 61(1):31-32, 1989.

ABSTRACT - This paper discussed the effect in a

5 year period (1983-88) of MDT on the Leprosy

situation in North Arcot District where MDT was

started in 1983.

The cases at the start of MDT were 68351 and

29511 cases were detected in the year period and the

total case load was 97862. Out of this total case load

84810 cases were deleted by RFC, deaths or PL. The

causes for deletions are discussed in detail.

The remaining case load at the end of the 5

year period is 13052 or 13,35% of the cases at start.

The M.D.T. has definitely played a part in the drastic

reduction of the case load since the major number of

cases have been deleted as RFC due to cure of the

disease and so the future plannintg of leprosy work

when the case load becomes very low is also

discussed.

ELLARD, G. A. et al. Clofazimine and dapsone

compliance in leprosy. Leprosy Rev., 59:205-

213, 1988.

SUMMARY - The regularity with which

multibacillary patients, who were being treated with

the WHO Study Group regimen In a THELEP-

sponsored fiel trial in South India, ingested their

prescribed daily clofazimine and dapsone was

studied. The ingestion of clofazimine was monitored

using a specially prepared

Hansen. Int. 14(2): 184-199,1989

formulation containing minute amounts of isoniazld as

an innocuous marker. Overall drug acceptability and

compliance was excellent. Approximately 75% of the

prescribed daily clofazimine and dapsone doses were

being ingested and it was concluded that only 5% of

the patients would have benefited if their treatment

had been supplemented by acedapsone injections.

There was however a marked correlation between the

self-administration of the 2 drugs with the

consequence that the patients at greatest risk of

developing rifampicin resistance because of poor

dapsone compliance were the very ones most unlikely

to take their daily clofazimine treatment. The results

obtained emphasize the importance of employing

regimens containing high degrees of supervised drug

administration, especially in areas where drug

compliance is known to be poor.

ELLARD, G. A. et al. Long Term prothionamide

compliance: a study carried out in India using a

combined formulation containing prothionamide,

dapsone and isoniazid. Leprosy Rev., 59:153-

175,1999.

SUMMARY - A comprehensive study of the self-

administration of prothionamide is described in which

over 2000 urine samples were collected from some 60

South Indian patients over a 2-year period.

Prothionamide (350 mg) was prescribed for daily self-

administration as the commercially available combined

formulation 'Isoprodian' that also contais dapsone and

isoniazld. Drug ingestion was monitored by testing the

samples qualitatively and quantitatively for the

presence of the isonicotinic acid, and for dapsone

together with is diazotisable metabolites.

About a third of the patients suffered from

moderate or severe gastrointestinal side-effects

attributed to prothionamid but no hepatic toxicity was

encountered, whether or not treatment was

supplemented with monthly supervised doses of

rifampicin. The results obtained using the different

urine-test methods correlated well and it was

concluded that overall just over half the prescribed

doses had been ingested. Although enormous

variations in individual patient compliance were

demonstrated, there was a continuous spectrum of

drug taking and patients could not be simply grouped

into good or poor compliers.

Older patients took their prescribed treatment

less regularly. The compliance of patients who

188

Hansen. Int. 14(2): 184-199,1989


suffered from severe gastrointestinal side-effects was

markedly impaired and improved when daily thioamid

treatment was replaced by dapsone. The proportion of

positive urine tests among samples collected at the

patients' monthly clinic visits was similar to those

collected by means of surprise home visits.

It was concluded that if prothionamide is used as an

alternative to clofazimine in the multidrug treatment of

lepromatous lea rosy its compliance should be

monitored using an isoniazid-marked formulation.

GEORGIEV, G. D. Blister Calendar Packs - Potential for

Improvement in the Supply and Utilization of

Multiple Drug Therapy in Leprosy Control

Programs. /Editorials/ Int. J. Leprosy,

56(4):603-610,1988.

SUMMARY - The concept of multiple drug therapy

(MDT) for leprosy has been widiy accepted and the

World Health Organization (WHO) recommended

regimens for paucibacillary (PB) and multibacillary

(MB) patients have been introduced in many leprosy

control programs worldwide. In recent yeas increasing

efforts have been made jointly by governments,

international organizations, and voluntary agencies to

expand and intensify MDT implementation in leprosy-

endemic countries. However, alongside the availability

of finance and infrastructure, there is a need for

careful revision of the operational methodology and

technology currently used in field control activities in

order to make this expansion more effective. One

important aspect of this improvement process, on

which the effectiveness of combined chemotherapy

crucially depends, is the constant availability of all the

required antileprosy drugs at the periphery and their

regular intake by patients for the prescribed period of

time. It has been suggested that the use of "bubble"

or "calendar" packs for the dispensing of drugs for the

treatment of leprosy, and perhaps also for

tuberculosis, has proved practical value.

GIRDHAR, A. at al. Drug compliance among self-

motivated leprosy patients. Indian J Leprosy,

60(4):506-509, 1988.

ABSTRACT - Regularity of DDS intake among 366

leprosy patients attending our out patient department

voluntarily was assessed by urine spot test. it was

found that only 54.6% of them had taken


their last dose of drug within the previous three days.

Those who kept their appointment showed better

compliance than those who did not. Urinary DDS

positivity was found to be unrelated to sex, occupation

or the type of the disease. In the younger age group

the compliance was low, as also among the patients

coming from nearby places as compared to those who

were residing in far off districts.

GROSSET, J. H. of al. Study of 39 Documented

Relapses of Multibacilary Leprosy After Treatment

with Rifampin. Int. J. Leprosy, 57(3):607-614,

1989.

SUMMARY - Among 39 strains of Mycobacterium

leprae isolated from patients with multibacillary

leprosy who relapsed after treatment with rifampin

(RPM), 22 strains were resistant to RMP and 17 were

susceptible. All of the RMP-resistant strains were

recovered from patients who had been treated with

more than 50 doses of RMP, usually given as

monotherapy. RMP-susceptible strains were recovered

from only six patients who had received more than 50

doses of RMP, and from 11 patients who had received

no more than sevem doses. The median time to

relapse after the beginning of RMP therapy was 9

years (range 1-12) among the patients harboring

RMP-resistant strains of M. leprae, and the median

time to relapse after discontinuation of RMP treatment

was 7 years (range 1-11 years) among the patients

harboring RMP-susceptible strains. These data suggest

that monotherapy with more than a few doses of RMP

can be responsible for the emergence of RMP -

resistant strains of M. leprae, thus emphasizing the

need to employ RMP only in combination with other

effective drugs in the chemotherapy of multibacillary

leprosy.

GRUGNI, A., NADKARNI, N. J. & KINI, M. S. Multidrug

therapy in paucibacillary leprosy -

five year experience. Indian J. Leprosy,

60(4):589-592, 1988.

ABSTRACT - 736 paucibacillary (PB) patients

were given multidrug therapy (MDT) for at least 6

months. Overall, 44% became inactive after 6 doses,

and 69% after 12 doses. However, 27% remained

active at the time of analysis, It is recommended that

at least 12 doses of MDT be given to PB patients

irrespective of the type.

HUAN-YING, L. at al. Short-term Multidrug Therapy in

Multibacilary Lerpsoy - Review of 80 Cases in Two

Provinces of China (1983-1988). Int. J. Leprosy,

57(3):622-627, 1989.

SUMMARY - Thirty-three active multibacillary

patients from nine counties of Weifang Prefecture,

Shandong Province, and 47 active cases from Mania

County, Yunnan Province, People's Republic of China,

were treated with 24 and 27 months of multidrug

therapy (MDT), respectively, in 1983. Clinical

assessments, smears, and histopathologic

examinations were carried out independently by study

teams from the Institutes of Dermatology of these two

provinces. Reexaminations at 12-14 months and at

termination of therapy showed marked improvement,

and there was continued improvement at 12-18 and

33 months on follow up. Conversion of the bacterial

index to negativity was 0/33, 5/47 for the patients

from Shandong and Yunnan provinces, respectively, at

the ends of MDT and 2/33 at 12 months' and 17/47 at

18 months' follow up, which increased to 21/33 and

26/44 at 33 months' follow up. Regression of specific

infiltration was about 21%-100% after 24-27 months

of MDT; further regression to 95%-100% occurred at

33 months's follow up.

IRUDAYA RAJ, P. P. et al. Certain aspects of dapsone

metabolism in leprosy patients as studied by high

performance liquid chromatography (HPLC) and

qualitative screening tests. Indian J. Leprosy,

60(2):25-224, 1988.

ABSTRACT - Dapsone (DDS) in urine of 250

leprosy patients collected on surprise visits were

screened by simple paper spot, tile tests and sensitive

Enzyme linked immunosorbent assay (ELISA) and

Haemagglutination inhibition (HI) tests. The urinary

DDS concentration as wel as DDS/C ratios were also

studied. Simultaneously, 50m1 of blood was collected

from each of these patients and its dapsone content

was estimated by HPLC. Urine samples with means of

25 to 30 mg/ml DDS and 55-64 mg/mg DDS/C ratios

were found to give positive tests by any of the above

screening procedures, while their mean blood DDS

concentration was found to be 0,91 mg/m1. The

corresponding values for those specimens giving

negative tests were 3.8 to 5.7 mg DDS per ml and 9

Hansen. Int. 14(2): 184-199,1989

to 13 mg/mg DDS/C ratio. The blood DDS

concentration in this group was ranging from 0.16 to

0.18 mg/ml. The findings are discussed in relation to

their metabolic significance and their application in a

leprosy control programme.

IRUDAYA RAJ, P. P. at al. Influence of acetylator

phenotype of the leprosy patient on the

emergence of dapsone resistant leprosy. Indian

J. Leprosy, 60(3): 400-406, 1988.

ABSTRACT - The half time of disappearance of

dapsone and monocetyl dapsone and the acetylator

phenotype of the leprosy patients who harboured

dapsone sensitive and dapsone resistant M. leprae

was assessed in 27 subjects. Sixteen patients were

rapid acetylator, five were slow and six were

intermediate acetylators. The mean T 1 1/2 lives of

dapsone (30.26 +- 11.0) and monoacetyl dapsone

(31.11 +- 12.0) were also studied in the above

patiens. The percentage of different acetylators in

both resistant and sensitive groups were similar

showing no correlation between the emergence of

drug resistance and the phenotype of the patient.

The mean time of disappearance of DDS and MAD in

the different acetylators did not show significant

difference. The ratios of MAD/DDS in an individual at

3.6 or 24 hours after the dose were similar. The

mean T 1 1/2 lives of DDS and MAD In resistant and

sensitive patients also showed no difference. Neither

T 1 1/2 lives of DDS or MAD nor the acetylator

phenotype seem to influence the emergence of

dapsone resistance.

JESUDAN, K. et al. Impact of MDT on leprosy as

measured by selective indicators. Leprosy Rev.,

59:215-223, 1988.

SUMMARY - The impact of multidrug therapy

(MDT) on the leprosy situation in endemic districts

where MDT has been introduced, Is studied, using a

hypothetical model.

This analysis indicates that there will be

significant falls in prevalence rates during the first 5

years, mainly as a result of discharge of cases during

screening and due to shortening of the duration of

treatment. These changes have to be Interpreted

with caution. Already some districts like Wardha in

India have shown dramatic falls in prevalence rates

from 1111 in 1981, to 1.8 in 1987.

190

Hansen. Int. 14(2): 184-199,1989


The Impact of MDT on disease transmission as

measured by decline in incidence rates and case

detection rates will, however, be gradual.

JESUDASAN, K.; PANNIKAR, V. & CHRISTIAN, M.

Infectivity of Secondary DApsone-resistant

Cases. Int. J. Leprosy, 418-421, 1988.

SUMMARY - The incidence rate of leprosy

among 517 household contacts of 113 cases of

secondary dapsone resistance with 5074 person years

at risk were studied. The incidence rate of leprosy was

4.3 per 1000 person years at risk, which is very similar

to the incidence rate (4.8) among household contacts

of lepromatous cases. Two, possibly three, cases of

primary dapsone resistance were detected among the

27 contacts who developed multibacillary leprosy.

There was no evidence of dapsone resistance among

48 paucibacillary leprosy cases assessed when treated

with dapsone monotherapy. The possibility that

secondary dapsone-resistant cases will infect and will

result in an increase in the number of primary

dapsone-resistant cases needs to be investigated

further.

JIA-KUN, C. et al. Primary dapsone resistance in

China. Leprosy Rev., 60(4):263-266, 1989.

SUMMARY - Ninety-seven strains of

Mycobacterium leprae recovered from patients with

previously untreated multibacillary leprosy were tested

for dapsone susceptibility. The specimens originated

from Shanghai Municipality, Jiang-su Province and Fu-

jian Province. Approximately 28% of the strains either

did not infect the mice or the results of susceptibility

were inconclusive due to the low proportion of viable

organisms in the bacterial populations. Among the 70

strains in which dapsone susceptibility could be tested

in mice, 31 (44%) strains were found with primary

dapsone resistance. Although the majority of the

primary dapsone resistant strains were shown to be of

a low-or intermediate-degree, one-sixth of them were

of high-degree resistance.

KAR, H. K. & ROY, R. G. Comparison of colchicine and

aspirin in the treatment of Type 2 lepra reaction.

Leprosy Rev., 59:201-203, 1988.


SUMMARY - In a double blind controlled trial, 34

episodes of acute Type 2 reaction in patients with

lepromatous leprosy were treated with colchicine (1.5

mg/dayx4) and the response was compared with a

similar number of episodes treated with aspirin (1.8

g/dayx4). Both drugs were found equally effective in

mild degree reaction, whereas conchicine gave

marginally better result in moderate degree reaction.

Neither of the drugs was found useful in severe

degree reaction. However, a better efficacy of

coichicine was observed in the management of joint

and nerve pain associated with Type 2 reaction. Minor

side-effects like diarrhoea, nausea and vomitign were

noted in only 1 patient while under coichicine therapy.

KAR, H. K. et aI. A clinico-patholgoical study of

multidrug regimen in paucibacillary leprosy.

Indian J. Leprosy, 60(2): 235-241, 1988.

ABSTRACT - Preliminary results of a clinical trial

in one hundred untreated paucibacillary leprosy cases

with multidrug therapy (MDT) as per WHO

recommendation are presented.

KATOCH, K. et al. Relapses in Paucibacillary Patients

After Treatment with Three Short-term Regimens

Containing Rifampin. Int. J. Leprosy,

57(21:458-464, 1989.

SUMMARY - Three multidrug regimens all

containing rifampin and dapsone have been tried for

the treatment of 278 cases of paucibacillary leprosy.

Regimen I was the one recommended by the WHO

Study Group. Regimen II was the same as Regimen I

with depsone alone continued for a further 6 months.

Regimen Ill was the same as Regimen II but rifampin

was given daily for the first 7 days. The patients were

comparable with regard to disease classification,

lepromi n status, bacteriological status, and number of

lesions. As reported earlier, the disease inactivity rates

by 1 year of treatment were much greater with

Regimens li and III than with Regimen 1(94% and

97% vs 76%).

Early reaction was seen in 6% of those in

Regimen Ill and in none in Regiments I and II. Late

reaction was observed in 9% of those in Regimen I

and none in Regimens II and Ill. During 31/2 years of

follow up, 13% of the cases in Regimen I. 1% in

Regimen II, and 2% in Regimen Ill relapsed. Since

the three regimens were other-wise comparable, it is

concluded that the high inactivity rate, low relapse

rate (1%-2%), and no early or Iate reaction as

observed in Regimen II patients were because of

adequate treatment.

KATOCH, K. et al. Results of Modified WHO Regimen

in Highly Bacilliferous BULL Patients. Int. J.

Leprosy, 57(2):451-457, 1989.

SUMMARY - Multidrug therapy (MDT) has been

advocated in all cases of multibacillary leprosy for

several reasons. Firstly, the problems of primary and

secondary drug resistance could be prevented.

Secondly, by using a combination of drugs with

different modes of action, Mycobacterium leprae are

attacked at different stages of their life cycle and

thus could be more effectively killed. Thirdly, in cases

who have already become dapsone resistant, only a

combination of drugs would be advisable. A World

Health Organization (WHO) Study Group has

recommended a multidrug regimen for 2 years or

longer for multibacillary patients. Different workers in

leprosy have also tried different multidrug regimens

and have advocated treatment for varying durations

for achieving the most effective bacterial kill and for

minimizing relapses. There have been only a few

reports of long-term follow-up of the effects of

mutlidrug treatment on highly bacilliferours leprosy

patients or of detailed studies on the results of MDT

regimens.

We have earlier reported the preliminary results

of a 2-year follow-up of highly bacillated

multibacillary patients on a modified WHO regimen.

The present study now reports the results of those

cases who have been followed up for 4 years. The

regimen used was the same as the WHO regimen

except that no monthly supervised loading doses,

i.e., 300 mg of clofazimine, were given and

clofazimine was administered 100 mg on alternate

days.

KATOCH, V. M. at al. Effecet of Chemotherapy on

Viability of Mycobacterium leprae as Determined

by ATP Content, Morphological Index and FDA-

EB Fluorescent Staining. Int. J. Leprosy,

57(3):615-621, 1989.

SUMMARY - Viable bacterial populations were

estimated in bacilli purified from 105 biopsies from 40

untreated and 65 multibacllary leprosy patients

Hansen. Int. 14(2): 184-199,1989

treated with multidrug therapy (MDT) for varying

periods. The bacilli were purified and viability was

determined by ATP content, morphological index (MI),

and fluorescein diacetate-ethidlun- bromide (FDA-EB)

staining. Viable populations were calculated, taking

3.58 x 10.15 g/solid bacillus as the mean ATP content

of a viable unit of Mycobacterium tepee. The

proportion of viable bacilli was also estimated in the

same specimens using solid-staining (MI) and green-

staining bacilli by the FDA-EB method. In the,

untreated cases, the positive viability by ATP assay

was 100%, 92% by MI, and 100% FDA-EB. ATP

content per solid bacillus was relatively constant,

which was not the case with ATP content per green-

staining bacillus. While the MI was zero in all cases,

viable bacilli could still be detected by ATP estimations

in 5 of (16%) patients after 2 years of MDT and in 1 of

the 20 (5%) patients after 3 years of MDT. No viable

bacilli could be detected even by this method beyond

3 years of MDT. On the other hand, green-staining

bacilli were demonstrable in 7/32 (22%) of cases after

2 years of MDT, 2/20 (10%) after 3 years of MDT, and

1/13 (8%) after more than 3 years of treatment,

indicating that the FDA-EB staining and ATP assay did

not detect the same populations. A determination of

the ATP content of M. /eprae could be used as a

reliable and sensitive tool for determining viability of

the bacilli.

KATOCH, K. at al. Pyrazinamide as a part of

combination therapy for BL and LL patients-a

preliminary report. Indian J. Leprosy. 56(1):1-

9, 1988.

SUMMARY - Pyrazinamide in a dose of 1500 mg

was given 63 borderline lepromatous (BL) and

lepromatous (LL) leprosy patients on different drug

regimens for the initial 2 months of therapy. Fifty-one

LL patients were put on the same drug regimens

without pyrazinamide. There was a rapid and good

clinical improvement in the patients in both of the

groups.At the end of 2 years, the patients who

received pyrazinamide had a morphological index (MI)

of zero as compared to those patients who did not

receive pyrazinamide, some of whom still had solidly

staining bacilli. One out of 20 (5%) scrotal (smooth

muscle) biopsies of the patients who received

pyrazinamide had growth in the mouse foot pad as

compared to 9 out of 38 (23.7%) smooth muscle

biopsies of the patients who did not receive

pyrazinamide. At the end of 5 years,

192

Hansen. Int. 14(2): 184-199,1989


the patients who received pyrazinamide had slightly

better results compared with the non-pyrazinamide

group. Pyrazinamide appears to have some effect

against persisters in multibacillary leprosy. A well-

controlled, randomized trial with longer duration of

pyrazinamide therapy in a larger group of patients

needs to be carried out to unequivocally determine the

exat role of pyrazinamide in leprosy.

KLENERMAN, P. Prostaglandins and leprosy. a role for

aspirin? Leprosy Rev. 60(1):51-58, 1989.

SUMMARY - Prostaglandins not only have a role

in inflammation, but may also be involved as

mediators in the immune response. Drugs which

affect prostaglandin synthesis may therefore be

potential tools with which to modulate disturbed

immunity. These possibilities are discussed with

reference to immunity in leprosy and particular

reversal reactions.

KULKARNI, V.; GHARPURAY, M. B. & KULKARNI, D.

S. Multiple cold abscesses in a borderline

lepromatous patient on multidrug therapy.

Indian J. Leprosy, 61(4): 442-444, 1989.

ABSTRACT - A 25-year-old male patient was

diagnosed as a case of borderline lepromatous (BL)

type of leprosy in erythema nodosum leprosum type

reaction. He was put on multidrug treatment. He took

regular treatment Approximately a year after the

begining of the treatment he developed multiple cold

abscesses and later tuberculosis of the left hip joint.

He was given antitubercular treatment with 4 drugs

and the abscesses were treated surgically. He

showed good response. This unusual case and the

role of intermitent rifampicin is discussed.

KURZ, X. M.; DECLERQ, E. E. & VELLUT, C. M.

Rate and Time Distribution of Relapses in

Multibacillary Leprosy. Int. J. Leprosy, 57(3);599-

606, 1989.

SUMMARY - Of the 47,068 patients registered in

the Polambakkan Leprosy Center between 1955 and

1982, we selected 1886 cases having shown

bacteriological positivity at any time during this


period, whatever their classifications at registration,

and subsequently found bacteriologically negative.

After an average follow-up period of 10 years, 243

relapses were observed, giving a crude relapse rate of

12.8 per person-years of observation and a cumulative

probability of relapse of 18.9%. Relapse rates were

found to be dependent on regularity during smear-

positive and negative periods; a regularity greater

than 75% in the smear-positive period proved to be

particularly important. The results show no evidence

that relapses occurring after 3 years of negativity

could be reinfections, and that the relapse rate was

still affected by regularity 7 years negativation. The

median delay of relapses was found to be 4.4 years

and was not affected by the regularity of treatment.

NAIK, S. S. et al. A bacteriological assessment of

multibacilary cases in leprosy colonies after 41/2

years of multidrug therapy. Indian J. Leprosy,

60(3):393-399, 1988.

ABSTRACT - In this presentation we have devised

a novel way of calculating the total bacterial quantum

in 100 (78 LL and 22 BL) multibacillary leprosy

patients living in leprosy colonies. The calculation is

based on Ridley's logarithmic scale. We have also

attempted to assess the reduction in the bacterial

quantum as a result of intervention through multidrug

therapy (MDT). 53% of the patients rendered

bacteriologically negative within two years of

treatment of MDT and 94% at 54th pulse dose i.e at

54th month. The bacterial quantum in human source

as leprosy patients was calculated thus - Average BI of

the group x Number of patients in each group x

Multiplication factor devised as per Ridley's Bacterial

Index (BI). By applying this purely arithmetic formula,

it was found that 99.8% of the bacerial load is

harboured in leprosy patients having BI more than 3.

The introduction of MDT initiated the reduction in total

bacterial quantum"based on above arithmetic scale"

was achieved very fast i.e., from 100% to 5% at 12

months and to 0.4% at 24 months. We believe that if

one wants to achieve leprosy control a reduction in

total bacterial quantum within a specific period,

leprosy cases with BI more than 3 should be treated

on priority basis.

NEVILLE, J. After multridrug therapy (MDT): who Is

responsible for continuing care? /Editorial/

Leprosy Rev., 59:1-3, 1988.

SUMMARY - Before considering who is

responsible for providing continuing care, it is

necessary to look at the present situation regarding

multidrug therapy (MDT).

Most leprosy endemic countries in the world have

introduced, or are In the process of introducing the

WHO recommended MDT regimens for leprosy.

However, data available in 1968 showed that only

8.8% of the total number of registered cases in the

world were receiving MDT. This was four years after

the WHO Study Group recommended that, as a matter

of urgency, combined chemotherapy regimens should

be introduced in all leprosy control programmes.

This slow progress in the introduction of MDT is

understandable to planners and field staff alike, and is

a cause for concern. It is partly due to inadequate

financial and personnel resources, and very often due

to transport problems. It could well be argued that

with limited resources, those that are available must

first be used for implementing MDT, and that it is

unrealistic to consider continuing care until all leprosy

patients have been treated with MDT. However, the

importance of patient care was underlined at a recent

meeting of WHO and nongovernmental organizations.

Some programme planners are already aware of this,

and recognize that continuing patient care not only

helps the individual but also reinforces the credibility

of the MDT programme.

NIGAM, P. K. at al. Rifampicin induced uterine

bleeding. Indian J. Leprosy, 60(2): 303-305,

1988.

ABSTRACT - A case of uterine bleeding after

intake of rifampicin is reported in a 35-year-old

female. Provocation test was also positive. The

underlying mechanism whether it has a

hypersensitivity phenomenon like fixed drug eruption

or due to induction of uterine acyl-hydrolase enzyme,

is not clear. Uterine bleeding has not been observed

as a side-effect of rifampicin in the past.

PARKING, A. A. & SHAH, B. H. Flu like syndrome with

rifampicin pulse therapy Indian J. Leprosy.

61(2): 209-210, 1989.

ABSTRACT - Flu like syndrome was found in a

Hansen. Int. 14(2): 184-199,1989

patient of BT leprosy taking Rifampicin in pulse

therapy. This side effect was absent when the dose

Rifampicin was decreased. Details of this case is

given with a review of literature.

TIWARI, V.D. et al. Multidrug therapy in hospitalised

leprosy cases. Indian J. Leprosy, 60(1): 71-

76, 1988.

ABSTRACT - Fifty eight cases including 44

paucibacillary and 14 multibacillary leprosy diagnosed

at Comnabd Hospital SC Pune were hospitalised for

the entire period of multidrug therapy, 76% cases

belonged to high endemic states of India. Reactions

occurred in 13 cases during treatment, type I in 10

and type II in three, 7 multibacillary cases

experienced reaction, 69% reaction patients

developed reaction within two months of starting

MDT and all of them were multibacillary. Usually it

took 3-6 months for majority (61.5%) of reactions

subside completely. In 65.5% paucibacillary patients

activity subsided within twelve months, however

70,5% paucibacillary cases took more than six

months to exhibit subsidence of activity. In 13

multibacillary cases activity subsided by 18 months

though bacteriological negativity was obtained from

four to twelve months.

PATKI, A. H.; JADHA, V. H. & MEHTA, J. M. syndrome

on once monthly rifampicin. Indian J.

Leprosy, 60(1):84-86, 1988.

ABSTRACT - Two cases of 'flu' syndrome on

once monthly rifampicin are reported. The symptoms

were reproduced in one patient with the next

supervised dose. In the second patient they did not

recur probably because she was receiving systemic

steroids for left ulnar neuritis.

PATRI, A. H. & MEHTA, J. M. Dapsone - Induced

erythroderma with Beau's lines. Leprosy Rev.,

60(4):274-277.1989.

SUMMARY - A 35-year-old female with

borderline lepromatous (BL) leprosy who suffered

from dapsone-induced erythroderma is reported.

Sudden onset of erythroderma gave rise to a

temporary arrest of the function of nail matrix with

the resultant Beau's lines. She rapidly recovered with

omission of dapsone and therapy with

194

Hansen. Int. 14(2): 184-199,1989


systemic corticosterois and a topical emollient. In

view of the potentially fatal hypersensitivity reaction,

we suggest that any patient on mutidrug therapy for

leprosy needs an urgent referral to a dermatologist if

the patient develops a skin rash during the first two

months of treatment.

PATTYN, S. R. at al. Combined regimens of one year

duration in the treatment of multibacillary

leprosy. I. Combined regimens with rifampicin,

adni nistered during one year. Leprosy Rev.,

61 (2):109-117, 1989.

SUMMARY - In 1981, 1982 and 1983, 216

multibacillary patients in Anjouan (Comores) and

Burundi were treated for 8 weeks with daily

rifampicin (600 mg) ethionamide (500 mg) and

dapsone (100 mg) or clofazimine (100 mg) followed

for 44 weeks by once weekly rifampicin (600 mg and

daily ethionamide (500 mg) and dapsone (100 mg) or

clofazimine (100 mg). There were 109 previously

untreated patients and 107 patients who had had

dapsone monotherapy, 16 of whom were infected

with proven dapsone resistantMycobacterium leprae.

Clinical and bacteriological results were excellent but

hepatotoxicity of this regimen remains a problem.

No relapses were observed during a 2 to 6 years

(mean.29 years) follow-up period after the end of

treatment (upper 95% confidence limit of 0.40 per

100 persons years). It is concluded that multibacillary

leprosy can ben successfully treated with a regimen

of one year duration, but less toxic regimens, more

easily applicable in the field, are necessary.

PATTYN, S. R. et al. Combined regimens of one year

duration in the treatment of multibacilary

leprosy. I. Combined regimens with rifampicin

administered during 6 months. Leprosy Rev.,

60(2):118-123, 1989.

SUMMARY - From 1981 to 1983 all multibacillary

patients presenting at the collaborating centres in

Zaire and Rwanda were treated with one of the

following regimens: 6 months supervised daily RMP

600 mg, ETH 500 mg and DDS 100 mg or CLO 100

mg followed by 6 months unsupervised daily DDS 100

mg or CLO 100 mg ETH 500 mg added or not. These

regimens gave rise to hepatotoxicity, reversal and

erythema


nodosum leprosum reactions as described previously.

Bactericidal activity was excellent. Among the

289 patients in the trial, with a mean follow-up period

of 3.88 years, no relapses were observed, with an

upper 95% confidence limit of 0.35 per 100 person

years.

Because of the hepatotoxicity, alternative short-

course therapies need to be tested.

PAVITHRAN, K. Relapse of paucibacillary leprosy after

short course multidrug therapy. Indian J.

Leprosy, 60(2):225-229, 1988.

ABSTRACT - Among 25 patients who had short-

course multidrug therapy as recommended by the

WHO for paucibacillary leprosy, 3 were observed to

develop relapse of their disease 8 to 12 months after

completion of treatment. These three cases of relapse

are reported in detail. The duration of chemotherapy

recommended by the WHO in paucibacillary cases

appears to be too short.

PIETERS, F. A. J. M.; WOONIK, F. & ZUIDEMA, J. A

field trial Among Leprosy Patients in Nigeria with

Depot Injections of Dapsone and

Monoacetyldapsone. Int. J. Leprosy, 56(1):10-

19, 1988.

SUMMARY - In two field trials in Nigeria, 74 male

and female leprosy outpatients received intra-adipose

depot injections of either dapsone (DDS) or

monoacetyldapsone (MADDS) at 4-week intervals.

Blood samples were taken regularly and sent to

Amsterdam to determine the DDS and MADDS

concentrations in serum using high-pressure liquid

chromatography (HPLC).

The DDS injection yielded a good sustained drug

release. After repeated administration accumulation

occurred, demonstrated by a statiscally significant

increase in the area under the curve (AUC) in time:

until 28 days after the first injection, the mean AUC

(+-S.D.) amounted to 19.3 +- 5.6 mg 0(/1 in males

and 15.1 +- 5.2 in females; after the fourth injection,

26.4 +- 7.5 and 24.6 +9.0 mg d/I, respectively (p —

0.001). One male patient developed an abscess at the

injection site; otherwise no side effects were

observed.

Even better sustained-release results were

observed with the MADDS injection. Unfortunately, the

injection caused a number of abscesses.

Consequently, the DDS injection was very well

received by the patients of the DDS study, while half

of the patients in the MADDS study would prefer

tablets to the MADDS injection.

Further investigations are required to find the

cause of the abscesses before one of the injections, or

possibly a combination of both, could be implemented

in the multidrug treatment regimen proposed by WHO

to provide a valuable tool to combat non-compliance

among leprosy patients.

RAMAKRISHNAN, K. R. et al. Paucibacillary leprosy: a

comparative study of different schedules of multidrug

therapy. Indian J. Leprosy, 60(4):542-548, 1988.

ABSTRACT - The study was undertaken to

evaluate the efficacy of various multidrug regimens

(MDT). Three groups of 10 cases each of

Paucibacillary cases were given different schedules of

multidrug therapy. First group (T-O) was administered

modified WHO regimen consisting of Rifampicin 600

mg once a month, Clofazimine 100 mg alternate days

and Dapsone 100 mg daily for 6 months. In second

group (T-1) Rifampicin 600 mg was given daily for 6

weeks and in third group (T-2) Rifampicin 600 mg was

given daily for 6 months. In both the latter groups

Clofazimine 100 mg on alternate days and Dapsone

100 mg daily was also administered for 6 months.

Objective clinical scoring was done at the time of

admission, three months and six months after

treatment in all three groups. The best results were

obtained by T-2 followed by T-1; and least effective

was T-0 regimen. Pinkish colour of urine and skin was

observed in 26 cases and icthyosis in all the cases. All

the patients remais under treatment. The work is in

progress and subsequent results will be published

later.

RAMU, G. & DESIKAN, K. V. A follow up study of

borderline tuberculoid leprosy under sulphone

monotherapy. Indian J. Leprosy, 60(1): 26-33,

1988.

ABSTRACT - A retrospective study is presentd

herewith of 94 cases classified as BT and treated with

sulphone monotherapy. A system of scoring based on

the number and extent of lesions, and nerve

involvement was followed. It was observed that cases

with a clinical score of 2 or having more

Hansen. Int. 14(2): 184-199,1989

than 15 lesions or patients with extensive lesions

covering 3 or more of 7 sectors of the body had bad

prognosis in respect of time taken for subsidence,

occurrence of deformities and most importantly

occurrence of relapses.

Hence it is suggested that such cases should be

considered as Multibacillary and treated as such,

despite bacteriological findings which may be either

negative or a bacteriological positivity of less than 2 at

any one site.

RAO, P. S. S. S. et al. Impact of MDT on Incidence

Rates of Leprosy Among Household Contacts Part

1. Baseline Data. Int. J. Leprosy. 57(3):647-

651, 1989.

SUMMARY - This preliminary study from

Gudiyatham Taluk, the leprosy control area of the

Schiefflin Leprosy Research & Training Centre,

investigated the incidence rates of leprosy among

household contacts during the period 1970-1985. The

incidence rates of leprosy among the household

contacts prior to and during the initiation of multidrug

therapy are presented here. The overall incidence rate

among the household contacts was 4 per 1000

person-years at risk. Contacts of multibacillary and

paucibacillary cases had a relative risk of 3-6 times

and 2-4 times the risk of leprosy in the general

population, respectively. The incidence rates among

children were higher than adults; the peak age-specific

incidence rate was between 5-9 years, and nearly one

third of the primary cases were children. These

findings are presented and the methodological issues

discussed.

REDDY, P. K. & MOTINUDDIN, S. K. Pattern of

relapses in pauci-bacillarey leprosy patients

treated with M.D.T. (W.H.O. 1982). Indian J.

Leprosy, 60(4): 581-588 1988.

ABSTRACT - Out of 92 Pauci-bacillary leprosy

patients treated with MDT (WHO 1982), two patients

developed Indisputable clinical signs of relapse during

10th and 26th month of observation period. Two more

patients developed reversal reaction during 8th and

12th month of observation period, which we presume

to be early manifestation of relapse. Addition of a

more bactericidal drug, rifampicim, appear to have a

bearing on the incidence of relapse, though not on it's

incubation

196

Hansen. Int. 14(2): 184-199,1989


period. No change of classification was notice at the

time of relapse. Incidence of relapse in female patients

was much higher than in male patients.

REDDY, P. K. Occurrence of reversal reactions in BT

patients during who paucibacillary leprosy MDT

(1982). Indian J. Leprosy, 60 (3): 453-456

1988.

ABSTRACT - 55 B.T. patients were with WHO

Paucibacillary MDT (1982). The patients suffered from

reversal reaction neither at the time of initiation of

MDT nor prior to that. During, the 6 months period of

MDT, one patient developed reversal reaction of a skin

patch, and another patient developed neuritis of a

peripheral nerve trunk.

REVANKAR, C. R. et al. Clinical assessment of

paucibacillary leprosy under multidrug therapy-

three years follow up study. Indian J. Leprosy,

61(3):355-359, 1989.

SUMMARY - 408 skin smear negative

paucibacillary leprosy cases who had completed six

months MDT were kept under surveillance for three

years. The clinical assessment at the end of

surveillance showed that 276 (82%) of all the cases

attained inactivity. Two patients who were inactive

showed signs of relapse. Five patients showed more

activity though they were regressing under treatment.

The inactivity rate was much higher amongst the

patients with 1 to 3 skin lesions (88't0) as compared

to the patients with — 4 lesions (60%).

The difference was statistically significant (P —

0.001). The past treatment before MDT did not appear

to influence the clinical course of the disease, 17% of

the patients essentially borderline type continued to

show signs of activity even after 3 years surveillance

indicating the need for triple drug therapy (to be

treated as multibacillary).

However larger scale data on relapse rate would

be essential before the efficacy of WHO short-term

therapy for paucibacillary leprosy is evaluated.

REVANKAR, C. R. et al. Delivery of MTD through blister

calendar packs in leprosy eradication

programmes - a multicentre field study (Phase I).

Leprosy Rev., 60(2): 135-138, 1989.


SUMMARY - To overcome operational problems

and improve patient compliance in leprosy

programmes, DANIDA introduced blister calendar

packs (BCP) to deliver MDT in four districts in India. A

questionnaire study of 1470 patients from these

districts showed that more than 90% accepted BCP

and found them to be very convenient for domiciliary

treatment. A similar study of 127 treatment providers

indicated that delivery of MDT through BCP was found

convenient to overcome logistic problems.

RICHARDUS, J. H. & SMITH, T. C. Increased incidence

in leprosy of hypersensitivity reactions to

dapsone after introduction of multidrug therapy.

Leprosy Rev., 60(4): 267-273, 1989.

SUMMARY - In order to address the question

whether hypersensitivity reactions to dapsone are

becoming more frequent, the clinical data of 7300

leprosy patients treated between 1949 and September

1988 at the McKean Rehabilitation Centre in Thailand

were reviewed.

Information from the period 1949 to 1969 was

too incomplete to allow conclusions. The incidence of

hypersensitivity reactions to dapsone between 1970

and 1982 was 0.3%. From 1982 (with, the

introduction of multidrug therapy) to September 1988,

the incidence was 3.6%; a tenfold increase compared

with the previous period Of the 19 cases seen since

1982, 12 were diagnosed as Dapsone syndrome. Of a

total of 13 patients seen since 1980 with Dapsone

Syndrome, 3 ended fatally, indicating the severity of

the complication.

The question is raised whether an unexplained

drug interaction with rifampicim is responsible for the

increase of hypersensitivity reactions to dapsone in

patients treated for leprosy.

ROSE, P. Change in epidemiological indices folowing

the introduction of WHO MDT into the Guyana

leprosy control programme. Leprosy Rev.,

60(2):151-156, 1989.

SUMMARY - In December 1981 the multidrug

regimen recommended by the WHO Study Group of

October 1981, was introduced into the Guyana

Hansen's Disease Programme. This paper examines

the changes that occurred in epidemiological

indices over the 6 years following the introduction of

MDT and also evaluates changing work loads and

staffing patterns.

ROY, B. & DAS, R. K. Cytogenetic Effect of Dapsone,

an antileprotic Drug, in the Mouse in Vivo

System. Int. J. Leprosy, 56(4):574-579, 1988.

SUMMARY - Potential genotoxicity of dapsone

was evaluated in mice following In vivo cytogenetic

assays. Adult male mice treated with different doses

(20mg, 40mg, or 80mg/kg/day for 4 weeks) and for

different periods (40 mg/kg/day for 2,4, or 8 weeks)

provided bone marrow and tests for mitotic and

meiotic chromosome analysis, respectively. A dose-

response (20 mg, 40 mg, or 80 mg/kg/day for 2

weeks) analysis was done with a separate set of mice

using a micronucleus test (MNT). Untreated mice

served as controls. Both the metaphase analysis and

MNT in bone-marrow cells revealed significantly higher

incidences of clastogenicity for all of the dose levels

and treatment periods. Chromosome aberrations, with

and without gaps, in bone-marrow metaphases

showed a positive correlation with the doses, but not

with the treatment periods. Correlation was also

lacking in the MNT. In the meiotic cells, the incidences

to chromosome aberrations increased significantly with

the highest dose and with the longest period of

treatment.

SINGHAL, S. K. Suicide with dapsone. Indian J.

Leprosy, 60(1): 87-89, 1988.

ABSTRACT - A case of suicide with dapsone is

reported in a female medico chemical analysis report

confirmed it to be death due to dapsone. Management

in case of dapsone poisoning is also discussed.

SINHA, S. et al. Appraisal of Two Mycobacterium

leprae-specific Serological Assays for Monitoring

Chemotherapy in Lepromatous (LUBL) Leprosy

Patients. Int. J. Leprosy. 57(1): 24-32, 1989.

SUMMARY - Two of the Mycobacterium leprae-

specific assays-a serum antibody competition (for an

epitope on 35-k Da protein) test

Hansen. Int. 14(2): 184-199,1989

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SACT) and an enzyme-linked immunosorbent assay

ELISA) for the dissaccharide epitope of phenolic

lycolipid-I (PGDS) - were comparatively evaluated as

ools for monitoring chemotherapy In 125 lepromatous

eprosy (LUBL) patients. An adaptation of the SACT

rom a radioimmunoassay (RIA) to an ELISA procedure

s also described. A moderate but statistically significant

orrelation was observed between the assays, although

ACT appeared to be the more sensitive of the two.

evels of antibodies correlated better with the bacterial

ndex (BI) than with the duration of treatment.

owever, wide individual variations in antibody levels

for a specific duration of treatment of BI) were seen in

reated well as untreated patients. Anti-PGDS antibody

esponse of the IgG type was poorer than that of the

gM type and, apparently, it did not have a bearing on

ither treatment duration or the BI. Further studies will

e needed to clarify whether the treated patients

howing a negative (or low) BI and high antibody levels

ere harboring hidden foci of active infection, and

hether treatment could safely be terminated in

atients showing low values for both BI and antibody.

IRUMBAN, P. KUMAR, A. & NEELAN, P. N. Healing

Time in Untreated Paucibacillary Leprosy: A

Cross-sectional Study. Int. J. Leprosy,

56(21:223-227, 1988.

SUMMARY - The healing time of leprosy lesions in

17 paucibacillary (PB) cases who took no antileprosy

reatment was estimated to be 2.03 +0.10 (mean +-

.E.) years in a leprosy hyperendemic area. This

ealing time does not appear to be influenced by

pidemiological characteristics of the patients such as

ge, sex, intrafamilial leprosy contact status, number

nd site of leprosy lesions, etc. It was also observed

hat the rate of healing and downgrading among the

otal untreated cases was 22.4% and 0.57%,

espectively, per year. About 39% of the total

ntreated PB leprosy cases healed within a period of 2

ears. The scientific implication of this observation is

iscussed.

UITE, M. & EDINBOROUGH, N. B. A second report on

multidrug therapy for leprosy In Trinidad and

Tobago. Leprosy Rev., 60(4):288-299,

1989.

SUMMARY - Multidrug therapy consisting of

rifampicin, clofazimine and dapsone, was introduced

Trinidad and Tobago in January 1982. This was with

slight modification of the WHO regimens. Since then

717 patients have completed multidrug therapy up to

the end of December 1987. Of these, 272 patients

have completd surveillance and have beam

discharged from clinic attendance. Thirty-four

patients died before completing surveillance and

three are known to have migrated. Of the remaining

408 cases still under surveillance, the majority are

multibacillary.

This paper reviews the outcome of multidrug

therapy in Trinidade and Tobago between January

1982 and December 1987 - a period of 6 years, and

presents some of the statistics related to the newly

diagnosed patients within the same period.

THAKUR, M. et al. Primary dapsone resistance as

assessed by uptake of labelled thymidine by the

macrophage resident Mycobacterium leprae.

Indian J. Leprosy, 61(4): 437-441 1989.

ABSTRACT - 12 untreated lepromatous leprosy

patients were screened for primary dapsone resistance

by the uptake of labelled thimidine by macrophage

resident M. leprae. Three were found to harbour

primary dapsone resistant strains of M. leprae and

another three partially resistant strains to the drug.

This rapid, simple and reliable method should be usual

routinely to screen leprosy patients for drug

resistance.

THOMAS, A. at al. A double-blind controlled clinicaltrial

to assess the role of anti-histaminesin the

treatment of multi-bacillary leprosy. Indian J.

Leprosy, 60(4):499-505, 1988.

ABSTRACT - A double blind controlled clinical trial

to assess the role of anti-histamines as a supplement

in the treatment of leprosy was conducted in

multibacillary cases of leprosy. In all, 130 patients with

lepromatous or borderline leprosy were randomly

allocated to a regimen of clofazimine and dapsone for

12 months with or without a supplement of

pheniramine maleate for the first 3 months. During the

12-month period, 92% of the patients who received

the supplement and 86% of the patients who hap not

received It had

98 (Janeiro de 1988 a Dezembro de 1989)

Hansen. Int. 14(2): 184-199,1989


moderate or marked clinical improvement. The BI

value decreased from 4.1 to 3.4 and 4.2 to 3.3,

respectively. The results over the 12-month period

showed that the addition of the antihistamine had not

enhanced the efficacy of the regimen as evidenced by

clinical and bacteriological findings.

TIWARI, V. D. at ah Multidrug therapy in hospitalised

leprosy cases. Indian J. Leprosy, 60(1):71-76,

1988.

ABSTRACT - Fifty eight cases including 44

paucibacillary and 14 multibacillary leprosy diagnosed

at Command Hospital SC Pune were hospitalised for

the entire period of multidrug therapy, 76% cases

belonged to high endemic states of India. Reactions

occurred in 13 cases during treatment, type I in 10

and type II in three, 7 Multibacillary cases experienced

reaction, 69% reaction patients developed reaction

within two months of starting MDT and all of them

were multibacillary. Usually it took 3-6 months for

majority (61.5%) of reactions subside completely. In

65.5% paucibacillary patients activity subsided within

twelve months, however 70.5% paucibacillary cases

took more than six months to exhibit subsidence of

activity. In 13 multibacillary cases activity subsided by

18 months though bacteriological negativity was

obtained from fourth to twelve months.

VAISHNAVI, C. at al. Effect of multidrug therapy on

the levels of antibodies to Mycobacterium leprae

glycolipid-1 in leprosy spectrum. Indian J.

Leprosy, 60(4):530-534, 1988.

ABSTRACT - Sera from one hundred an forty

five untreated leprosy patients, ten proven cases of

active pulmonary tuberculosis and twenty five healthy

volunteers not exposed to M. leprae infection were

assayed for PGL-1 antibodies. All available follow up

samples after multidrug therapy were also assayed. A

decline in the level of PGL-1 antibodies were seen in

many of the post-treatment samples, giving an indirect

assessment of the bacterial load and the prognosis of

the disease.

VAN BRAKEL, W. at al. Relapses after multidrug

therapy for leprosy: a preliminary report of 22

cases in west Nepal. Leprosy Rev., 60(1): 45-50,

1989.

SUMMARY - The WHO recommended multidrug

therapy regimens for leprosy patients were

implemented in Nepal from 1982. Therefore a

considerable number of both paucibacillary (PB) and

multibacillary (MB) patients have been on observation

after release from MDT, for as long as 4-5 years. A

retrospective study was done considering the patients

who relapsed during this period and who were

registered at the Out-patients Department of Green

Pastures Hospital in Pokhara, Nepal. A total of 22

patients relapsed out of 927 who were released from

MDT.

VAZ, M. at al. "Flu" syndrome on once monthly

rifampicin: a case report. Leprosy Rev., 60(4):

300-302, 1989.

SUMMARY - 'Flu' syndrome as a complication of

intermittent weekly administration of rifampicin is well

documented. The rare occurence of 'flu' syndrome on

once monthly rifampicin is reported in this paper.

ZEIS, B. M. at al. Inhibition of mononuclear leukocyte

transformation in vitro by dihydrophenazinas in

comparison to clofazimine. Leprosy Rev., 59:31-

35, 1988.

SUMMARY - To identify the molecular structures of

the antileprosy drug clofazimine which mediate its

immunosuppressive activity the effects of ten

phenazine derivatives on phytohaemagglutinin-

stimulated mononuclear leukocyte (MNL)

transformations were investigated. It was found that

modifications in the substituent at position 2 of the

dihydrophenazine moiety decreased the

antiproliferative activity. The nature of the chemical

group in position 2 also influenced the

immunomodulatory effect of halogenation in the

paraposition of the phenyl-rings and anilino-rings.

Hansen. Int. 14(2): 184-199,1989

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